Post-Intensive Care Syndrome—10 Years after Its Proposal and Future Directions

Inoue, Shigeaki; Nakanishi, Nobuto; Nakamura, Kensuke

doi:10.3390/jcm11154381

Cited by 6 publications

(7 citation statements)

References 27 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients admitted to the ICUs frequently develop PICS [ 19 ]. Insights into how intense PA should be targeted during the ICU stay for early recovery could help avoid increasing reliance on ADLs during hospital discharge for critically ill patients [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Watanabe¹,

Yamauchi²,

Yasumura³

et al. 2023

Cureus

View full text Add to dashboard Cite

Background The mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU) and predict functional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activities of daily living (ADL) dependence has been shown. We created and validated the Japanese version of the MQS using the endpoint ADL in a mixed population of patients in the ICU. Materials and methods In this prospective study, consecutive patients who were admitted to one of three ICUs of a tertiary care hospital in Japan, aged ≥18 years, and who received mechanical ventilation for >48 hours were enrolled. The Japanese version of the MQS was applied twice daily by an ICU physiotherapist and data recorded for analysis. The primary outcome was ADL dependence at hospital discharge, defined as a Barthel index (BI) of <70 or in-hospital death. The reliability among assessors was verified by calculating the interclass correlation coefficient (ICC) (2.1) for the average daily MQS. We performed a multiple logistic regression analysis to examine and identify a binary cutoff point for high-/low-dose rehabilitation. Results Of the 340 target patients, eight were aged <18 years, 109 had neurological complications, 11 had a BI <70 before admission, 79 had a lack of communication skills, 16 were terminally ill, eight did not complete the assessment during their ICU stay, 18 died in the ICU, and 53 denied consent. After 302 patients were excluded, 38 were included in the study. Six assessors, two at each hospital, measured the MQS in 38 patients. The ICC (2.1) for the MQS mean value was 0.98 (0.96-0.99) during the ICU stay. Logistic regression analysis using the mean MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at discharge (odds ratio (OR): 0.76, confidence interval (CI): 0.61-0.96, adjusted p = 0.009). Logistic regression analysis using a high MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at hospital discharge (OR: 0.14, CI: 0.03-0.66, adjusted p = 0.013). Conclusions We present a validated version of the Japanese MQS with a high inter-rater reliability that predicts ADL dependence at hospital discharge. The instrument can be used in future clinical trials in the ICU to control for the mobilization level in the ICU. The increased utilization of mobilization acutely in the ICU setting as quantified by the MQS may improve patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Watanabe¹,

Yamauchi²,

Yasumura³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…The analysis took into account several factors such as age, Barthel index before hospitalization, planned operation, septic shock, APACHE II score, and use of continuous vasopressors. These variables were selected based on the results of previous studies 2,4,11,24,28,38,39 . We limited the number of covariates to six to prevent overfitting the model 40 .…”

Section: Data Collectionmentioning

confidence: 99%

“…(1) The association between the achievement of mobilization and outcomes within 2, 3, 4, 6, or 7 days after ICU admission was examined using the same method (multiple logistic regression analysis) as the primary analysis. (2) We included those who died after ICU discharge in the ADL non-independent group because the association between EM and fatality is assumed to be bidirectional, and ADL non-independence can result from fatality. ADL non-independence may be associated with in-hospital mortality (3) To address other potential confounders of ADL independence, we selected different covariates to assess the robustness of our findings.…”

Section: Data Collectionmentioning

confidence: 99%

Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge

Watanabe

Hirasawa

Naito

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Physical dysfunction after discharge from the intensive care unit (ICU) is recognized as a common complication among ICU patients. Early mobilization (EM), defined as the ability to sit on the edge of the bed within 5 days, may help improve physical dysfunction. However, the barriers to, and achievement of, EM and their impact on physical dysfunction have not been fully investigated. This study aimed to investigate the achievement of EM and barriers to it and their impact on patient outcomes in mechanically ventilated ICU patients. We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU between April 2019 and March 2020, were aged ≥ 18 years, and received mechanical ventilation for > 48 h were eligible. The primary outcome was the rate of independent activities of daily living (ADL), defined as a score ≥ 70 on the Barthel index at hospital discharge. Daily changes in barriers of mobilization, including consciousness, respiratory, circulatory, medical staff factors, and device factors (catheter, drain, and dialysis), along with the clinical outcomes were investigated. The association among barriers, mobilization, and Barthel index ≥ 70 was analyzed using multivariable logistic regression analysis. During the study period, 206 patients were enrolled. EM was achieved in 116 patients (68%) on the fifth ICU day. The primary outcome revealed that achieving EM was associated with a Barthel index ≥ 70 at hospital discharge [adjusted odds ratio (AOR), 3.44; 95% confidence interval (CI), 1.70–6.96]. Device factors (AOR, 0.31; 95% CI, 0.13–0.75, respectively) were significantly associated with EM achievement. EM was associated with independent ADL at hospital discharge. Time to first mobilization and barriers to achieving mobilization can be important parameters for achieving ADL independence at discharge. Further research is required to determine the most common barriers so that they can be identified and removed.

show abstract

“…Physical sequelae of PICS can include muscle weakness, fatigue, and chronic pain, while psychological and cognitive sequelae can manifest as anxiety, depression, post-traumatic stress disorder (PTSD), and cognitive impairment [8] which significantly reduce the quality of life [9] . Physical impairment is observed in one-third of patients six months after ICU discharge, and long-term physical disability is seen in approximately 30% of survivors.…”

mentioning

confidence: 99%

“…Cognitive impairment is observed in about 40% of patients after three to six months of critical illness. Frailty is an important risk factor for PICS and can lead to increased hospital mortality and prolonged ICU and in-hospital length of stay [9] . These symptoms can persist for months or even years after discharge from the ICU and can significantly impact a patient’s ability to return to normal activities, including work and social relationships [10] .…”

mentioning

confidence: 99%

What’s going on with Covid-19 right now?

Planas-Pascual

Rello

2023

Anaesthesia Critical Care & Pain Medicine

View full text Add to dashboard Cite

Post-Intensive Care Syndrome—10 Years after Its Proposal and Future Directions

Abstract: With the development of intensive care medicine and the standardization of various therapeutic guidelines and education systems, mortality rates in critically ill patients have improved markedly [...]

Cited by 6 publications

References 27 publications

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge

What’s going on with Covid-19 right now?

Contact Info

Product

Resources

About