Variables associated with mobility levels in critically ill patients: A cohort study

Raurell-Torredà, M.; Arias-Rivera, S.; Martí, Joan Daniel; Frade-Mera, M.J.; Zaragoza-García, Ignacio; Velasco-Sanz, T.R.; José‐Arribas, Alicia San; Blázquez-Martínez, Eva

doi:10.1111/nicc.12639

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…Optimizing nursing and physical therapy resources is critical to improving the ability of critically ill patients to mobilize, and this will have significant mortality benefits. 42 Although this work has great potential to improve patient care, there are clearly limitations. The work was based on a relatively small sample size of patients of one type (critically injured patients).…”

Section: Discussionmentioning

confidence: 99%

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Using a real-time ABCDEF compliance tool to understand the role of bundle elements in mortality and delirium

Shampo

Wenszell

Luo-Owen

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:ABC-123, a novel Epic electronic medical record real-time score, assigns 0 to 3 points per bundle element to assess ABCDEF bundle compliance. We sought to determine if maximum daily ABC-123 score (ABC-MAX), individual bundle elements, and mobility were associated with mortality and delirium-free/coma-free intensive care unit (DF/CF-ICU) days in critically injured patients. METHODS:We reviewed 6 months of single-center data (demographics, Injury Severity Score [ISS], Abbreviated Injury Scale of the head [AIS-Head] score, ventilator and restraint use, Richmond Agitation Sedation Score, Confusion Assessment Method for the ICU, ABC-MAX, ABC-123 subscores, and mobility level). Hospital mortality and likelihood of DF/CF-ICU days were endpoints for logistic regression with ISS, AIS-Head, surgery, penetrating trauma, sex, age, restraint and ventilator use, ABC-MAX or individual ABC-123 subscores, and mobility level or a binary variable representing any improvement in mobility during admission. RESULTS:We reviewed 172 patients (69.8% male; 16.3% penetrating; median age, 50.0 years [IQR, 32.0-64.8 years]; ISS, 17.0 [11.0-26.0]; AIS-Head, 2.0 [0.0-3.0]). Of all patients, 66.9% had delirium, 48.8% were restrained, 51.7% were ventilated, and 11.0% died. Age, ISS, AIS-Head, and penetrating mechanism were associated with increased mortality. Restraints were associated with more than 70% reduction in odds of DF/CF-ICU days. Maximum daily ABC-123 score and mobility level were associated with decreased odds of death and increased odds of DF/CF-ICU days. Any improvement in mobility during hospitalization was associated with an 83% reduction in mortality odds. A and C subscores were associated with increased mortality, and A was also associated with decreased DF/CF-ICU days. B and D subscores were associated with increased DF/CF-ICU days. D and E subscores were associated with decreased mortality. CONCLUSION:Maximum daily ABC-123 score is associated with reduced mortality and delirium in critically injured patients, while mobility is associated with dramatic reduction in mortality. B and D subscores have the strongest positive effects on both mortality and delirium.

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Section: Discussionmentioning

confidence: 99%

“…One common theme is the importance of early mobility, perhaps one of the most difficult tenets of the bundle to implement. Optimizing nursing and physical therapy resources is critical to improving the ability of critically ill patients to mobilize, and this will have significant mortality benefits 42 …”

Section: Discussionmentioning

confidence: 99%

Using a real-time ABCDEF compliance tool to understand the role of bundle elements in mortality and delirium

Shampo

Wenszell

Luo-Owen

et al. 2022

J Trauma Acute Care Surg

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“…Patients in intensive care unit (ICU) have a high incidence of muscle atrophy and contracture, loss of mobility, muscle weakness, and general reduction in fatigue resistance, which are proportional to the immobilization time and loss of function [1][2][3]. The first 7 days of bedrest can already lead to $26% loss of muscle mass [4]. This generalized muscle weakness, which is unrelated to the patient's acute disease or its treatment, is called "Intensive Care Unit Acquired Weakness" (ICUAW).…”

Section: Introductionmentioning

confidence: 99%

“…ICUAW can affect both the peripheral and respiratory muscles and leads to important reductions in the functional capacity of ICU patients and is associated with a higher risk of death [1, 5]. Early and noninvasive assessment of these patients, such as the use of handgrip strength evaluation [6], muscle strength by Medical Research Council score (MRC) [7], Intensive Care Unit Mobility Scale (IMS) [8, 9], and quantification of length of stay in the ICU is essential to monitor these patients and for clinical decision making [4].…”

Section: Introductionmentioning

confidence: 99%

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Neto,

Espósito,

da Rocha

et al. 2024

Journal of Biophotonics

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ContextPhotobiomodulation therapy (PBMT) has been widely used to improve strength, fatigue resistance and increase muscle mass in healthy individuals. These effects could help critically ill patients admitted to intensive care units (ICUs) who show reduced mobility and muscle strength. ICU‐acquired weakness lessens overall health and increases the patient's length of stay in the ICU.ObjectiveThis study evaluated the effects of PBMT using low intensity light‐emitting diodes (LEDs) on the mobility and muscle strength (functional capacity) and length of stay of patients admitted to hospital ICU.MethodsThis randomized, triple‐blind, sham‐controlled trial was conducted in a hospital ICU. Sixty patients were randomly assigned to two equal groups: (a) PBMT and (b) Sham. PBMT was applied daily to patients until their discharge from the ICU, using a flexible neoprene array of 264 LEDs (120 at 635 nm, 1.2 mW each; 144 at 880 nm, 15 mW each) for 90s (207.36 Joules) at each site. Ten sites were located bilaterally on the thighs, legs, arms, and forearms ventrally and dorsally, 15 min totaling 2,073.6 Joules per session. Outcomes were length of stay (in h) until discharge from the ICU, muscle strength by the Medical Research Council (MRC) score and handgrip dynamometry (HGD), patient mobility by Intensive Care Unit Mobility Scale (IMS) and the Simplified Acute Physiology Score 3 (SAPS 3) for predicting mortality of patients admitted to the ICU.ResultsPBMT reduced the average length of stay in the ICU by ~30% (p = 0.028); increased mobility (IMS: 255% vs. 110% p = 0.007), increased muscle strength (MRC: 12% vs. −9% p = 0.001) and HGD (34% vs. −13% p < 0.001), and the SAPS3 score was similar (p > 0.05).ConclusionThe results suggest that daily PBMT can reduce the length of stay of ICU patients and increase muscle strength and mobility.

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“…Approximately 60%-100% of patients with sepsis will eventually develop ICUAW, which is characterized by decreased muscle strength that leads to persistent physical impairment (2,3). ICUAW has an incidence of 40%-46% (4). The underlying pathophysiological effects of ICUAW are complex and have not been fully clarified but include limited autophagy, mitochondrial dysfunction, inflammasome activation, cell death, and necroptosis (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Sepsis Leads to Impaired Mitochondrial Calcium Uptake and Skeletal Muscle Weakness by Reducing the Micu1:mcu Protein Ratio

Li,

Sun,

et al. 2023

Shock

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Purpose Intensive care unit-acquired weakness (ICUAW) is a severe neuromuscular complication that frequently occurs in patients with sepsis. The precise molecular pathophysiology of mitochondrial calcium uptake 1 (MICU1) and mitochondrial calcium uniporter (MCU) in ICUAW has not been fully elucidated. Here, we speculate that ICUAW is associated with MICU1:MCU protein ratio-mediated mitochondrial calcium ([Ca2+]m) uptake dysfunction. Methods Cecal ligation and perforation (CLP) was performed on C57BL/6 J mice to induce sepsis. Sham-operated animals were used as controls. Lipopolysaccharide (LPS) (5 μg/mL) was used to induce inflammation in differentiated C2C12 myoblasts. Compound muscle action potential (CMAP) was detected using a biological signal acquisition system. Grip strength was measured using a grip-strength meter. Skeletal muscle inflammatory factors were detected using ELISA kits. The cross-sectional area (CSA) of the tibialis anterior (TA) muscle was detected by hematoxylin and eosin staining. Cytosolic calcium ([Ca2+]c) levels were measured using Fluo-4 AM. Adeno-associated virus (AAV) was injected into TA muscles for 4 weeks to overexpress MICU1 prophylactically. A lentivirus was used to infect C2C12 cells to increase MICU1 expression prophylactically. Findings The results suggest that sepsis induces [Ca2+]m uptake disorder by reducing the MICU1:MCU protein ratio, resulting in skeletal muscle weakness and muscle fiber atrophy. However, MICU1 prophylactic overexpression reversed these effects by increasing the MICU1:MCU protein ratio. Conclusions ICUAW is associated with impaired [Ca2+]m uptake caused by a decreased MICU1:MCU protein ratio. MICU1 overexpression improves sepsis-induced skeletal muscle weakness and atrophy by ameliorating the [Ca2+]m uptake disorder.

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Variables associated with mobility levels in critically ill patients: A cohort study

Cited by 8 publications

References 38 publications

Using a real-time ABCDEF compliance tool to understand the role of bundle elements in mortality and delirium

Using a real-time ABCDEF compliance tool to understand the role of bundle elements in mortality and delirium

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

Sepsis Leads to Impaired Mitochondrial Calcium Uptake and Skeletal Muscle Weakness by Reducing the Micu1:mcu Protein Ratio

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