Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patient Population
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Rehabilitation during the ICU Stay
3.3. Barriers to and Safety Events in the Implementation of Mobilization in the ICU
4. Discussion
4.1. Clinical Implication
4.2. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ICU | intensive care units |
APACHE II score | Acute Physiology and Chronic Health Evaluation II score |
IMS | ICU Mobility Scale |
SD | standard deviation |
IQR | interquartile range |
References
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Unplanned Admission n = 134 | Elective Surgery n = 69 | p Value | |
---|---|---|---|
Age, year, median (IQR) | 74.5 (62.3, 81.0) | 68.0 (57.0, 74.0) | 0.023 |
Sex, Female, n (%) | 83 (61.9) | 48 (69.6) | 0.353 |
BMI, median (IQR) | 22.3 (20.0, 24.9) | 23.5 (21.0, 26.2) | 0.118 |
Reason for ICU admission, n (%) | <0.001 | ||
Cardiovascular disease | 41 (30.6) | 39 (56.5) | |
Respiratory disease | 33 (24.6) | 5 (7.3) | |
Abdominal/gastrointestinal disease | 19 (14.2) | 21 (30.4) | |
Sepsis | 28 (20.9) | 0 (0) | |
Renal/metabolic disease | 7 (5.2) | 0 (0) | |
Other | 6 (4.5) | 4 (5.8) | |
Charlson Comorbidity Index, median (IQR) | 2.0 (0.25, 3.0) | 2.0 (1.0, 3.0) | 0.442 |
Barthel Index prior to hospital admission, mean (SD) | 96.6 (9.9) | 97.4 (9.3) | 0.176 |
APACHE II score, median (IQR) | 20.0 (14.3, 26.8) | 18.0 (14.0, 22.0) | 0.03 |
SOFA at ICU admission, median (IQR) | 7.3 (9.4) | 7.0 (5.0, 10.0) | 0.593 |
Mechanical ventilation, n (%) | 81 (60.5) | 47 (68.1) | 0.221 |
Ventilator days, day, median (IQR) | 1.9 (0, 5.4) | 1.0 (0, 2.0) | 0.167 |
Length of ICU stay, day, median (IQR) | 5.0 (4.0, 9.0) | 4.5 (3.0, 6.4) | 0.016 |
Length of hospital stay, day, median (IQR) | 24.0 (15.0, 45.0) | 28.0 (21.0, 51.1) | 0.02 |
ICU death, n (%) | 10 (7.5) | 0 (0) | 0.017 |
Hospital death, n (%) | 25 (18.7) | 0 (0) | <0.001 |
During the ICU Stay | Unplanned Admission n = 134 | Elective Surgery n = 69 |
---|---|---|
Time from ICU admission to the start of rehabilitation programs, day, median (IQR) (n = 134) | 1.1 (0.7, 2.0) | 0.8 (0.5, 2.0) |
Time from ICU admission to sitting on the edge of the bed, day, median (IQR) (n = 120) | 3.0 (2.0, 5.0) | 1.9 (0.9, 4.0) |
Time from ICU admission to standing, day, median (IQR) (n = 117) | 4.4 (2.6, 6.7) | 2.8 (1.5, 6.1) |
Time from ICU admission to walking, day, median (IQR) (n = 107) | 6.0 (3.4, 10.1) | 4.0 (2.7, 7.9) |
Max IMS, Median (IQR) | 5 (3, 8) | 6 (3, 9) |
Total rehabilitation sessions | 1049 sessions | 386 sessions |
Rehabilitation activity time, min, mean ± SD | 19.4 ± 17.3 | 26.4 ± 19.0 |
IMS level 3, n (%) | 446 (42.5) | 200 (51.8) |
ROM, n (%) | 476 (45.3) | 114 (29.5) |
EMS, n (%) | 162 (15.4) | 6 (1.6) |
Respiratory physiotherapy, n (%) | 283 (27.0) | 101 (26.2) |
Sitting on the edge of the bed, n (%) | 160 (15.3) | 46 (11.9) |
Standing, n (%) | 166 (15.8) | 68 (17.6) |
Waking, n (%) | 122 (11.6) | 88 (22.8) |
Unplanned Admission | Elective Surgery | |||
---|---|---|---|---|
Mobilized at IMS Level 3 or Higher | Mobilized at IMS Level 3 or Higher | |||
No, 603 Sessions | Yes, 446 Sessions | No, 186 Sessions | Yes, 200 Sessions | |
IPPV/NPPV, n (%) | 303 (50.2) | 113 (25.3) | 116 (62.4) | 22 (11.0) |
Vasopressor, n (%) | 264 (43.8) | 99 (22.2) | 104 (55.9) | 43 (21.5) |
CHDF, n (%) | 94 (15.6) | 35 (7.8) | 23 (14.1) | 1 (0.5) |
Sedation, n (%) | 256 (42.5) | 93 (20.9) | 88 (47.3) | 19 (9.5) |
Analgesia, n (%) | 313 (51.9) | 151 (33.9) | 114 (61.3) | 75 (37.5) |
Delirium, n (%) | 89 (14.8) | 53 (11.9) | 26 (14.1) | 14 (7.0) |
RASS before rehabilitation, Median (IQR) * | −1 (−2, 0) | 0 (0, 0) | 0 (−1, 0) | 0 (0, 0) |
Physical restraint before rehabilitation, n (%) * | 244 (40.7) | 139 (31.2) | 90 (50.6) | 5 (2.5) |
Total safety events | 21 (3.5) | 77 (17.3) | 7 (3.8) | 26 (13.0) |
Hyper/hypotension † | 9 (1.5) | 39 (8.7) | 5 (2.6) | 26 (13.0) |
Sinus tachy/bradycardia ‡ | 2 (0.3) | 14 (3.1) | 0 (0) | 0 (0) |
Arrhythmia | 0 (0) | 1 (0.2) | 0 (0) | 0 (0) |
Desaturation § | 7 (1.2) | 13 (2.9) | 2 (1.0) | 0 (0) |
Tachy/Hypopnea || | 3 (0.5) | 4 (1.3) | 0 (0) | 0 (0) |
Unplanned catheter removal | 0 (0) | 6 (1.3) | 0 (0) | 0 (0) |
A fall | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Death | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Reason | Unplanned Admission | Elective Surgery |
---|---|---|
Number of Respondents = 930, n (%) | Number of Respondents = 218, n (%) | |
Unstable circulatory status | 278 (29.9) | 32 (14.7) |
Catheterization of the femoral artery/vein † | 148 (15.9) | 27 (12.4) |
Coma/deep sedation | 125 (13.4) | 23 (10.6) |
Unstable respiratory status | 106 (11.4) | 24 (11.0) |
Specific diseases requiring bed rest * | 69 (7.4) | 1 (0.5) |
Inadequate staffing/excessive workloads | 65 (7.0) | 11 (5.1) |
Patient symptoms (painful/dyspnea/ fatigue) | 35 (3.8) | 20 (9.17) |
Laboratory tests and/or procedures | 21 (2.3) | 8 (3.7) |
Extreme musculoskeletal weakness | 13 (1.4) | 3 (1.4) |
Delirium/agitation | 11 (1.2) | 5 (2.3) |
A postoperative bed rest order by a physician | 0 (0) | 51 (23.4) |
Unclear reason | 59 (6.3) | 13 (6.0) |
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Sakuramoto, H.; Nakamura, K.; Ouchi, A.; Okamoto, S.; Watanabe, S.; Liu, K.; Morita, Y.; Katsukawa, H.; Kotani, T. Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study. J. Clin. Med. 2023, 12, 3955. https://doi.org/10.3390/jcm12123955
Sakuramoto H, Nakamura K, Ouchi A, Okamoto S, Watanabe S, Liu K, Morita Y, Katsukawa H, Kotani T. Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study. Journal of Clinical Medicine. 2023; 12(12):3955. https://doi.org/10.3390/jcm12123955
Chicago/Turabian StyleSakuramoto, Hideaki, Kensuke Nakamura, Akira Ouchi, Saiko Okamoto, Shinichi Watanabe, Keibun Liu, Yasunari Morita, Hajime Katsukawa, and Toru Kotani. 2023. "Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study" Journal of Clinical Medicine 12, no. 12: 3955. https://doi.org/10.3390/jcm12123955