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Eggmann S1,2, Verra ML1, Luder G1, Bastiaenen CH3, Jakob SM4
1Inselspital, Bern University Hospital, Department of Physiotherapy, Bern, Switzerland, 2Maastricht University, Department of Epidemiology. Research Line Functioning and Rehabilitation CAPHRI, Maastricht, Netherlands, 3Maastricht University, Department of Epidemiology, Research Line Functioning and Rehabilitation CAPHRI, Maastricht, Netherlands, 4Inselspital, Bern University Hospital, University of Bern, Department of Intensive Care Medicine, Bern, Switzerland
Background: Intensive care unit acquired weakness (ICUAW) develops within days of critical illness leading to increased morbidity and mortality. Early rehabilitation may improve outcomes, but targeting persons at risk is challenging in clinical practice. Additionally, little is known about their short and long-term functional recovery.
Purpose: The aims of this secondary analysis of a randomised controlled trial were twofold: to characterise physical functioning of previously independent ICU survivors with versus without ICUAW at hospital discharge and 6-months, and to investigate risk factors for ICUAW until ICU discharge.
Methods: Two early exercise regimes delivered by physiotherapists within 48 hours of ICU admission were investigated in this trial that did not find a significant difference between the two groups. Participants (n=115) were ≥18 years, expected to remain ventilated for >72 hours and independent before critical illness. ICUAW was clinically diagnosed with the Medical Research Council sum-score with a cut-off 48 points in cooperative participants at ICU discharge. At hospital discharge, the 6-Minute Walk Test, Timed 'Up & Go' and Functional Independence Measure were assessed. Six-months later, participants completed the Short-Form 36 (SF-36) questionnaire. Statistical analyses included Fisher's exact, students-t or Mann-Whitney-U tests between groups. Risk factors were investigated with logistic regression. The level of significance was p 0.05.
Results: Eighty-three participants (72%) completed a clinical ICUAW assessment. Main reasons for non-completion were death (n=16) or absent cooperation (n=12). The incidence of ICUAW at ICU discharge was high (59%). Physical functioning at hospital discharge was significantly impaired in participants with versus without ICUAW; 6-Minute Walk Test (p=0.015; n=77, “with” 155m[IQR 199], “without” 215m[IQR 262]), Functional Independence Measure (p=0.024, n=77, “with” 104[IQR 36], “without” 110[IQR 27]) and Timed 'Up & Go' (p=0.028, n=57, “with” 23s[IQR 19], “without” 14s[IQR 16]). Length of hospital stay was significantly longer for participants with versus without ICUAW (p=0.012, n=83, 26 days [IQR 22] versus 19 days [IQR 18]). However, after 6-months this cohort had similar values for health-related quality of life (SF-36; physical component (p=0.625, n=49, mean-difference “with” minus “without” ICUAW (95%-CI): -1.5[-7.7 to 4.7]), mental component (p=0.448, n=49, -2.4[-8.1 to 3.9]) and mortality (p=0.753, n=83, overall: 14.5%, “with” 16.3%, “without”: 11.8%). ICU risk factors that were significantly associated with ICUAW at ICU discharge were the Sequential Organ Failure Assessment (SOFA) at study inclusion (OR 1.283 [95%-CI: 1.060 to 1.554]) and gender (OR for males 0.284 [0.081 to 0.995]), whereas training intensity, type, previous function or ICU-length were not.
Conclusion(s): This critically ill cohort had a high, possibly underestimated, ICUAW incidence with significant functional impairment at hospital discharge along with longer length of stay. However, contrary to previous evidence, participants seemed to recover after 6-month and mortality was not affected. More research is needed to investigate on how to achieve recovery and who should be targeted.
Implications: ICUAW is associated with worse short-term functional recovery and longer hospital stays, yet health-related quality of life may be regained. Early SOFA (>8) and female gender might be indicators for ICUAW that should be used by physiotherapists to identify persons at risk early and to initiate rehabilitation.
Keywords: Functional recovery, health-related quality of life, intensive care unit acquired weakness
Funding acknowledgements: This study was supported by the Department of Physiotherapy and Intensive Care Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
Purpose: The aims of this secondary analysis of a randomised controlled trial were twofold: to characterise physical functioning of previously independent ICU survivors with versus without ICUAW at hospital discharge and 6-months, and to investigate risk factors for ICUAW until ICU discharge.
Methods: Two early exercise regimes delivered by physiotherapists within 48 hours of ICU admission were investigated in this trial that did not find a significant difference between the two groups. Participants (n=115) were ≥18 years, expected to remain ventilated for >72 hours and independent before critical illness. ICUAW was clinically diagnosed with the Medical Research Council sum-score with a cut-off 48 points in cooperative participants at ICU discharge. At hospital discharge, the 6-Minute Walk Test, Timed 'Up & Go' and Functional Independence Measure were assessed. Six-months later, participants completed the Short-Form 36 (SF-36) questionnaire. Statistical analyses included Fisher's exact, students-t or Mann-Whitney-U tests between groups. Risk factors were investigated with logistic regression. The level of significance was p 0.05.
Results: Eighty-three participants (72%) completed a clinical ICUAW assessment. Main reasons for non-completion were death (n=16) or absent cooperation (n=12). The incidence of ICUAW at ICU discharge was high (59%). Physical functioning at hospital discharge was significantly impaired in participants with versus without ICUAW; 6-Minute Walk Test (p=0.015; n=77, “with” 155m[IQR 199], “without” 215m[IQR 262]), Functional Independence Measure (p=0.024, n=77, “with” 104[IQR 36], “without” 110[IQR 27]) and Timed 'Up & Go' (p=0.028, n=57, “with” 23s[IQR 19], “without” 14s[IQR 16]). Length of hospital stay was significantly longer for participants with versus without ICUAW (p=0.012, n=83, 26 days [IQR 22] versus 19 days [IQR 18]). However, after 6-months this cohort had similar values for health-related quality of life (SF-36; physical component (p=0.625, n=49, mean-difference “with” minus “without” ICUAW (95%-CI): -1.5[-7.7 to 4.7]), mental component (p=0.448, n=49, -2.4[-8.1 to 3.9]) and mortality (p=0.753, n=83, overall: 14.5%, “with” 16.3%, “without”: 11.8%). ICU risk factors that were significantly associated with ICUAW at ICU discharge were the Sequential Organ Failure Assessment (SOFA) at study inclusion (OR 1.283 [95%-CI: 1.060 to 1.554]) and gender (OR for males 0.284 [0.081 to 0.995]), whereas training intensity, type, previous function or ICU-length were not.
Conclusion(s): This critically ill cohort had a high, possibly underestimated, ICUAW incidence with significant functional impairment at hospital discharge along with longer length of stay. However, contrary to previous evidence, participants seemed to recover after 6-month and mortality was not affected. More research is needed to investigate on how to achieve recovery and who should be targeted.
Implications: ICUAW is associated with worse short-term functional recovery and longer hospital stays, yet health-related quality of life may be regained. Early SOFA (>8) and female gender might be indicators for ICUAW that should be used by physiotherapists to identify persons at risk early and to initiate rehabilitation.
Keywords: Functional recovery, health-related quality of life, intensive care unit acquired weakness
Funding acknowledgements: This study was supported by the Department of Physiotherapy and Intensive Care Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
Topic: Cardiorespiratory; Cardiorespiratory
Ethics approval required: Yes
Institution: Inselspital, Bern University Hospital, Bern, Switzerland
Ethics committee: Ethics Committee of Bern, Switzerland
Ethics number: Original study number: 122/12
All authors, affiliations and abstracts have been published as submitted.
