ADVANCED CRITICAL CARE PHYSICAL REHABILITATION PATHWAY; A PROSPECTIVE COHORT STUDY OF INTENSIVE VERSUS TRADITIONAL PHYSICAL REHABILITATION OF MECHANICALLY VENTILATED PATIENTS

T. Parey¹, A.K. Saharan², S. Dikshith³, S. Reddy⁴, S.S. Neerudu⁵, D. Parey⁶

¹Apollo Health City, Physiotherapy and Rehabilitation, Hyderabad, India, ²Maharaj Vinayak Global University, Department of Physiotherapy, Jaipur, India, ³Apollo Health City, Orthopaedics, Hyderabad, India, ⁴Apollo Health City, Critical Care Medicine, Hyderabas, India, ⁵THF International Home Health Care Pvt Ltd, Physiotherapy and Rehabilitation, Hyderabad, India, ⁶CHIREC, IBDP, Hyderabad, India

Background: There is a growing evidence for critical care physical rehabilitation within ICU for ventilated patients, however, there is little knowledge regarding early mobilisation in routine ICU practice. Advanced critical care physical rehabilitation pathway for mechanically ventilated patients provides benefits in terms of reducing ICU delirium, ICU length of stay, duration of mechanical ventilation and hospital length of stay.

Purpose: The objective of this study is to follow over time and compare the outcomes of advanced critical care and physical rehabilitation pathway with traditional rehabilitation of mechanically ventilated patients with regard to functional independence, muscle strength, decreased duration of ventilation and decreased ICU length of stay.

Methods: This prospective cohort study was performed in Advanced Critical Care Department (ACCU) at Apollo Health City, Hyderabad. A total of 100 patients aged between 30 to 60 years who were mechanically ventilated either conscious, drowsy or unconscious were included in the study. Patients were randomly allocated in Advanced Critical Care Rehab (ACCR) group and traditional physiotherapy group. Base line data on all patients mechanically ventilated for at least 3 days for 12 months would be compared with all patients mechanically ventilated for at least 3 days in 12 months after the introduction of ACCR Pathway. Results were evaluated with regard to functional independence at ICU discharge (accessed by Functional Independence Measure), muscle strength (accessed by manual muscle strength), mean duration of ventilation and ICU length of stay.

Results: The mean duration ofventilation (days) in ACCR group was 3.86 and traditional group was 8.18, length of ICU stay in ACCR was 6.04 and traditional group was 9.88, functional independence in ACCR group was 4.63 and traditional group was 2.33, muscle strength score in ACCR group was 3.63 and traditional group was 2.35. The P-value =0.001 is significant in ACCR group compared to traditional group.

Conclusions: ​​​​Mobilizing mechanicallyventilated patients while on ventilator is an approach to evidence based standards of world class with ACCR Pathway. It has attained good patients outcomes like;
1) Improved functional independence
2) Improved muscle strength
3) Decreased duration of ventilation stay
4) Decreased ICU length of stay

Implications:^​ACCR Pathway is a new paradigm of mechanically ventilated patients by providing potential benefits of early mobilisation in critical care rehabilitation compared to traditional physiotherapy in ICU.

Funding acknowledgements: Self

Keywords:
ACCR
ACCU
ICU

Topics:
Critical care

Did this work require ethics approval? Yes

Institution: Apollo Health City

Committee: Clinical Ethics Committee

Ethics number: AHC 54107