PHYSICAL INACTIVITY OF TWO PATIENTS WITH PROLONGED INTENSIVE CARE UNIT STAY: USING THE CONCEPT OF INACTIVITY BREAKS

M. Leiva-Corvalán^1,2, F. González-Seguel^1,2, J. Leppe¹, A. Camus-Molina^1,2

¹School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile, ²Servicio de Medicina Física y Rehabilitación, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

Background: Early mobilization in the intensive care unit (ICU) has focused on improving functional outcomes of critically ill patients. However, physical inactivity of patients ranges between 92 and 98% of the total time of the ICU stay. The specific characteristics of inactivity in critically ill patients are still unknown.

Purpose: To describe the physical inactivity behavior in two patients with prolonged ICU stay using inactivity breaks of the accelerometry records.

Methods: Secondary analysis of a prospective observational study approved by Ethics Committee Clínica Alemana Universidad del Desarrollo (#2017–104). Physical activity/inactivity was recorded by triaxial accelerometer (Actigraph®GT9X–Link) during the ICU stay of 30 adult patients who required mechanical ventilation. On awakening and at ICU discharge, mobility was measured with the Functional Status Score for the Intensive Care Unit (FSS-ICU), and muscle strength with the Medical Research Council Sum Score (MRC-SS). Severe weakness was defined as MRC-SS <36 points and significant weakness as <48 points. From the total sample, we selected two patients (A and B) with the longest ICU stay (30 and 35 days, respectively). We used the accelerometry record of the first ten days from the awakening of each patient. We describe the inactivity behavior according to the number and duration of inactivity breaks, defined as any interruption of the inactivity with ≥100 counts/minute. The number of inactivity breaks is presented per day and during the first ten days from awakening. The duration of inactivity breaks is presented in time intervals per hour: 0 minutes, 1-4 minutes, 5-9 minutes, 10-14 minutes, 15-29 minutes, and ≥30 minutes per day.

Results: Both patients were ≥65 years old, mechanically ventilated for >10 days, and had severe weakness on awakening. Patient A was female and admitted by oncological illness, and patient B was male and admitted by sepsis. The number of inactivity breaks for patients A and B was 363 and 296 breaks in ten days, respectively. The median [IQR] of inactivity breaks per day was 35 [33–39] and 28 [24–35] breaks per day for patients A and B, respectively. The number of inactivity breaks ≥30 minutes per hour corresponds to 103 and 53 breaks of the first ten days from awakening for patients A and B, respectively. The number of inactivity breaks from 1 to 29 minutes per hour corresponds to 99 and 114 breaks for patients A and B, respectively. At ICU discharge, the MRC-SS was 56 and 18 points, achieved by patients A and B, respectively; and the FSS-ICU was 25 and 8 points, respectively.

Conclusions: The patient with more number and duration of inactivity breaks obtained better results at ICU discharge.The findings identified in these two cases should be confirmed in studies with a custom sample size to demonstrate if the interruption of inactivity in the ICU promotes better functional outcomes.

Implications: The number and duration of inactivity breaks seem to provide new information about the immobility behavior of critically ill patients, which could be related to modifying muscle strength and mobility.

Funding acknowledgements: Supported by the School of Physical Therapy (Universidad-del-Desarrollo). Partially funded by the Unidad-de-Investigación-y-Ensayos-Clínicos at the Clínica Alemana, Santiago, Chile.

Keywords:
Critical Care
Sedentary behavior
Rehabilitation

Topics:
Critical care
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Clínica Alemana Universidad del Desarrollo, Santiago, Chile

Committee: Ethics Committee Clínica Alemana Universidad del Desarrollo

Ethics number: #2017–104