Does 6-Month Home Caregiver-Supervised Physiotherapy Improve Post-Critical Care Outcomes?

Vitacca, Michele; Barbano, Luca; Vanoglio, Fabio; Luisa, Alberto; Bernocchi, Palmira; Giordano, Amerigo; Paneroni, Mara

doi:10.1097/phm.0000000000000441

Cited by 21 publications

(41 citation statements)

References 32 publications

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“…They demonstrated that an early neurorehabilitation protocol carried out during ICU period could increase chance of decannulation by more than 300% for tracheostomized patients affected by acquired brain injury. Vitacca et al ( 30 ) also confirmed the relationship between physiotherapy and probability of decannulation. They found that eighty-three% of critical care survivors underwent physical exercise were decannulated vs. 14% of controls.…”

Section: Discussionmentioning

confidence: 81%

Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study

Wang

Wang²,

Wang³

et al. 2022

Front. Neurol.

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BackgroundTracheostomy is a lifesaving procedure provided for patients with severe neurological injury. However, there is a lack of clarity about whether patients can be decannulated within 6 months in those receiving tracheostomy and what factors can be detected as a predictor for decannulation.ObjectiveThe objective of this study was to explore predictive factors of decannulation in patients with neurological injury receiving tracheostomy within 6 months and construct a novel nomogram model for clinical diagnosis and treatment.MethodsThis retrospective observational study enrolled patients with neurological injury who were admitted to the ICU of neurosurgical department in the First Affiliated Hospital of Nanjing Medical University between January 2016 and March 2021. Patients were divided into decannulation group and cannulation group according to whether tracheostomy tube removal was performed within 6 months after tracheostomy. Multivariable logistic regression analysis was performed to determine associated risk factors with a bootstrap backward selection process. The nomogram to assess the probability of decannulation at 6 months was constructed based on the regression coefficients of the associated factors and validated by bootstrap resampling. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility (Kaplan–Meier curves stratified by the tertile of the predicted probability calculated and subgroup analysis stratified by age and intervention).ResultsA total of 40.1% (147/367) of patients decannulated within 6 months. Significant variables in multivariable logistic regression analysis were age (odds ratio [OR], 0.972; 95% confidence interval [CI], 0.954–0.990), National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.936; 95% CI, 0.911–0.963), early rehabilitation (OR, 5.062; 95% CI, 2.889–8.868), shock (OR, 0.175; 95% CI, 0.058–0.533), and secondary surgery (OR, 0.210; 95% CI, 0.078–0.566). The area under receiver operating characteristic curve estimated with these variables was of 0.793 (95% CI, 0.747–0.838; P < 0.001). A nomogram prediction model was constructed to predict the probability of decannulation in tracheostomized patients with a concordance index of 0.788 after internal validation.ConclusionWe developed a nomogram that can predict the probability of decannulation within 6 months in tracheostomized neurological injury patients. The nomogram, including age, NIHSS scores, early rehabilitation, shock, and secondary surgery, may assist clinicians in estimating patients' prognosis.

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Section: Discussionmentioning

confidence: 81%

Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study

Wang

Wang²,

Wang³

et al. 2022

Front. Neurol.

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“…Duration of mechanical ventilation as an inclusion criterion varied from a minimum of 24 24,29,30 to 96 27 hours and an ICU length of stay ranging from 24 hours 31 to 20 consecutive days. 32 Two studies excluded patients who had a hospital admission or an ICU stay within a specified time period. 25,29,32 Exclusion criteria for these studies varied widely, but most excluded patients with pre-illness neurocognitive or psychiatric conditions such as dementia, substance abuse, suicidal ideation, or profound communication disorders.…”

Section: Samplementioning

confidence: 99%

Optimizing Recovery Following Critical Illness: A Systematic Review of Home-Based Interventions

Holod

Choi

Tate

2022

Home Health Care Management & Practice

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Around 5 million Americans are treated in an intensive care unit (ICU) annually. Upon discharge, it is not uncommon for ICU survivors to experience psychological, physical, or cognitive symptoms related to their ICU stay. Home-based interventions have been touted as a potential treatment modality for post-ICU sequelae. However, limited evidence exists regarding the effectiveness of home-based interventions for patients in the post-ICU recovery period. As such, the purpose of this review was to aggregate and summarize the findings of studies focused on post-ICU rehabilitation, following critical illness, delivered in the home setting. A literature search was performed in MEDLINE, CINAHL, EMBASE, APA PsycINFO, and Google Scholar. Studies were included if they: used a RCT or quasi-experimental study design; included participants aged ≥18 years discharged home from an ICU; examined the effectiveness of a home-based, post-ICU intervention; were published in English after the year 2010; and were peer-reviewed. Nine studies met inclusion criteria. Sample sizes ranged from 21 to 386, with most participants receiving mechanical ventilation. Target outcomes included: physical function, psychological well-being, cognitive function, quality of life, and healthcare utilization. Interventions included face-to-face, web-based, telephone, or self-directed activities. Findings of included studies were mixed or inconclusive. Limitations of this review include: inclusion of only adult ICU survivors, exclusion of Post-Intensive Care Syndrome as a search term, and search restricted to pre-pandemic studies. Findings suggest a need for more rigorous research to develop and test home-based interventions.

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“…Post-traumatic stress disorder (PTSD) and strain are seen in 21% of the caregivers [ 120 ]. A randomized trial, where caregivers provided respiratory physiotherapy at home, showed improvement of the cardiorespiratory status of the patients and their HRQoL (as measured with the EuroQoL 5D methodology) [ 121 , 122 ]. While the majority of the above-mentioned studies were not specifically designed for the very elderly patient group, it seems logical that the perceived strain, depressive symptoms and HRQoL will also translate to this group of caregivers.…”

Section: Long-term Outcomes Are the Best Criteria To Judge Appropriatmentioning

confidence: 99%

Caring for the critically ill patients over 80: a narrative review

Guidet

Vallet

Boddaert

et al. 2018

Ann. Intensive Care

112

101

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BackgroundThere is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments.Main bodyIn this review, we report recent literature focusing on older critically ill patients in order to help physicians in the multiple-step decision-making process. It is unclear under what conditions older patients may benefit from ICU admission. Consequently, there is a wide variation in triage practices, treatment intensity levels, end-of-life practices, discharge practices and frequency of geriatrician’s involvement among institutions and clinicians. In this review, we discuss important steps in caring for critically ill older patients, from the triage to long-term outcome, with a focus on specific conditions in the very old patients.ConclusionAccording to previous considerations, we provide an algorithm presented as a guide to aid in the decision-making process for the caring of the critically ill older patients.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0458-7) contains supplementary material, which is available to authorized users.

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Does 6-Month Home Caregiver-Supervised Physiotherapy Improve Post-Critical Care Outcomes?

Abstract: Carrying over regular bronchial hygiene techniques, physical activity, and exercise into the home after long critical care stays is safe and has a beneficial effect on respiratory muscles, decannulation, pulmonary function, and quality of life.

Cited by 21 publications

References 32 publications

Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study

Development and validation of a nomogram for decannulation in patients with neurological injury: A prognostic accuracy study

Optimizing Recovery Following Critical Illness: A Systematic Review of Home-Based Interventions

Caring for the critically ill patients over 80: a narrative review

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