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González Seguel F.A.1,2, Lee Goic J.E.2,3, Cárcamo Ibaceta M.4,5, Blaitt Convalía A.A.2,3, Castillo Merino F.A.2,3, Ugarte Ubiergo S.6,7
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2Centro de Paciente Crítico Clinica INDISA, Kinesiología Intensiva y Terapia Respiratoria, Santiago, Chile, 3Universidad Nacional Andrés Bello, Facultad de Ciencias de la Rehabilitación, Santiago, Chile, 4Instituto Nacional del Cáncer, Centro de Responsabilidad de Investigación, Santiago, Chile, 5Universidad de los Andes, Departamento de Salud Pública y Epidemiología, Santiago, Chile, 6Centro de Paciente Crítico Clinica INDISA, Santiago, Chile, 7Universidad Nacional Andrés Bello, Facultad de Medicina, Santiago, Chile
Background: The importance of maintenance and recovery of functional mobility during ICU stay is to prevent the negative effects that its deterioraition has on the productivity of survivors after hospital discharge, delaying their return to work and to family duties, decreasing the availability of hospital beds, increasing waiting lists and ultimately raising healthcare costs. Despite the importance of this subject, there is usually no record of fuctional mobility (FM) indicators in many places, and therefore, status and level of FM in the ICU is unknown.
Purpose: The aim was to describe the functional mobility (FM) both on awakening and at ICU discharge. The secondary objective was to explore the correlation between FM with the amount of days under deep sedation, days on mechanical ventilation, presence of ICU delirium and total days with absolute bed rest. In addition, the association between the presence of intensive care unit acquired weakness (ICU-AW) on awakening and the amount of days under deep sedation was explored.
Methods: A descriptive study was performed in a medical and surgical ICU from March 2, 2015 to March 2, 2016 in patients on mechanical ventilation with previous functional independence (Karnofsky Performance Status Scale >70%). FM was assessed with the still not validated Spanish translation of the Functional Status Score for the Intensive Care Unit (FSS-ICU) on awakening and at ICU discharge. The awakening was defined as the first time the patient was able to answer standardized five questions (S5Q). ICU-AW was defined with a MRC SS (Medical Research Council Sum Score) 48 points, and ICU delirium with positive CAM-ICU (Confusion Assessment Method for the ICU).
Results: From 80 analyzed subjects the median FSS-ICU was 17 points on awakening and 26 points at ICU discharge. Exploration between FSS-ICU on awakening and deep sedation showed a negative correlation (rho=-0.39; p=0.000). Exploration between the FSS-ICU at ICU discharge and days on mechanical ventilation showed a negative correlation (rho=-0.36; p=0.001), as well as the presence of ICU delirium (rho=-0.25; p=0.027) and days with absolute bed rest (rho= -0.31, p=0.005). When exploring, the presence of ICU-AW on awakening and the number of days under deep sedation, there was a statistically significant negative association (odds ratio=0.1 (95% CI 0.035 to 0.275) p=0.000).
Conclusion(s): Approximately one out of five patients were discharged with severe dismobility. Deep sedation, days on mechanical ventilation, the presence of ICU delirium and days with absolute bed rest, produced deterioration with significant clinical importance in FM.
Implications: The importance of this study is to allow a basis for objective knowledge on functional mobility and their relationships with some of the risk factors associated with ICU stay. The application of measuring instruments in this study, was associated with significant increase in adhesion by physical therapists, and are still used as part of daily practice.
Funding acknowledgements: There was no funding source.
Topic: Critical care
Ethics approval: Approved by Comité Ético-Científico Servicio Metropolitano Oriente, Chile on December 2014. All patients (or legal representative) signed the informed consent.
All authors, affiliations and abstracts have been published as submitted.
