ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 1 (2020), REHABILITATION IN INTENSIVE CARE
No. 1 (2020)
REHABILITATION IN INTENSIVE CARE

Assessment and identification of predictors of performance of early rehabilitation of patients in the general intensive care unit. Article

Published 02.03.2020
S.A. Andreychenko
Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, Russia Academy of Postgraduate Education FMBA of Russia, Department of Anesthesiology and Intensive Care, Moscow, Russia
https://orcid.org/0000-0002-3180-3805
M.V. Bychinin
Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, Russia Academy of Postgraduate Education FMBA of Russia, Department of Anesthesiology and Intensive Care, Moscow, Russia
https://orcid.org/0000-0001-8461-4867
T.V. Klypa
Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies FMBA of Russia, Moscow, Russia Academy of Postgraduate Education FMBA of Russia, Department of Anesthesiology and Intensive Care, Moscow, Russia
https://orcid.org/0000-0002-2732-967X
#2020-1
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Keywords

prognostic markers
rehabilitation efficiency
functional recovery scales
early rehabilitation
rehabilitation potential

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1.
Andreychenko S.A., Bychinin M.V., Klypa T.V. Assessment and identification of predictors of performance of early rehabilitation of patients in the general intensive care unit. Article. Annals of Critical Care. 2020;(1):33-40. doi:10.21320/1818-474X-2020-1-33-40
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Abstract

Introduction. Currently, there are no universal criteria for assessing the volume of predicted functional recovery of patients during rehabilitation in intensive care units. Objective. To identify independent predictors of efficiency of rehabilitation of patients after a critical illness. Materials and methods. The study was conducted on the basis of a general ICU in 2017–2019. Patients with a short course of rehabilitation (≤ 7 days), deep impairment of consciousness (≤ 7 points on the Glasgow coma scale), decompensated multiple organ failure were excluded from the study. Clinical and laboratory data of 82 patients were retrospectively analyzed, including baseline severity of the condition, degree of functional independence and mobility, assessment of neurological deficit, incidence of depression and delirium, duration of mechanical ventilation and terms of hospitalization. We used a calculated indicator to analyze the effectiveness of rehabilitation — the rehabilitation potential index (RPI). Patients were assigned to the group of effective rehabilitation (ER) or ineffective rehabilitation (IR) depending on the level of RPI. Results. The duration of mechanical ventilation, the frequency of impaired consciousness and the duration of hospitalization were higher in the IR group than in the ER group. Сonsciousness impairment was found to be an independent predictor of low efficacy of the rehabilitation (odds ratio 4.53; confidence interval 95 % 1.63–12.6; p < 0.05). Conclusions. RPI can be used as a tool for assessing the effectiveness of rehabilitation of patients after a critical illness. The duration of mechanical ventilation has a negative effect on the functional outcome at discharge from the intensive care unit. The initial level of consciousness can be a benchmark for predicting the effectiveness of rehabilitation. Further prospective studies are needed to identify predictors of the effectiveness of early rehabilitation.
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References

  1. Tipping C.J., Harrold M., Holland A., et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Medicine. 2016; 43(2): 171–183. DOI: 10.1007/s00134-016-4612-0
  2. Schaller S., Anstey M., Blobner M., et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. The Lancet. 2016; 388(10 052): 1377–1388. DOI: 10.1016/s0140-6736(16)31637-3
  3. Kayambu G., Boots R., Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med. 2015; 41(5): 865–874. DOI: 10.1007/s00134-015-3763-8
  4. Schweickert W., Pohlman M., Pohlman A., etal. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet. 2009; 373(9678): 1874–1882. DOI: 10.1016/s0140-6736(09)60658-9
  5. McWilliams D., Jones C., Atkins G., et al. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial. J Crit Care. 2018; 44: 407–412. DOI: 10.1016/j.jcrc.2018.01.001
  6. Dong Z. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014; 5(1): 48. DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.008
  7. Wieczorek B., Burke C., Al-Harbi A., Kudchadkar S. Early Mobilization in the Pediatric Intensive Care Unit: A Systematic Review. J Pediatr Intensive Care. 2015; 04(04): 212–217. DOI: 10.1055/s-0035-1563386
  8. Kinoshita T., Nishimura Y., Nakamura T., et al. Effects of physiatrist and registered therapist operating acute rehabilitation (PROr) in patients with stroke. PLoS ONE. 2017; 12(10): e0187099. DOI: 10.1371/journal.pone.0187099
  9. Intiso D. ICU-acquired weakness: should medical sovereignty belong to any specialist? Critical Care. 2018; 22(1). DOI: 10.1186/s13054-017-1923-7
  10. Olkowski B., Shah S. Early Mobilization in the Neuro-ICU: How Far Can We Go? Neurocrit Care. 2016; 27(1): 141–150. DOI: 10.1007/s12028-016-0338-7
  11. Kamo T., Momosaki R., Suzuki K., et al. Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database. Journal of Stroke and Cerebrovascular Diseases. 2019. DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.007
  12. Ferrante L., Pisani M., Murphy T., et al. Functional Trajectories Among Older Persons Before and After Critical Illness. JAMA Intern Med. 2015; 175(4): 523. DOI: 10.1001/jamainternmed.2014.7889
  13. Turon M., Fernández-Gonzalo S., de Haro C., et al. Mechanisms involved in brain dysfunction in mechanically ventilated critically ill patients: implications and therapeutics. Ann Transl Med. 2018; 6(2): 30–30. DOI: 10.21037/atm.2017.12.10
  14. Hope A., Morrison R., Du Q., et al. Risk Factors for Long-Term Brain Dysfunction after Chronic Critical Illness. Ann Am Thorac Soc. 2013; 10(4): 315–323. DOI: 10.1513/annalsats.201211–099oc
  15. Hopkins R.O., Jackson J.C. Assessing neurocognitive outcomes after critical illness: are delirium and long-term cognitive impairments related? Curr Opin Crit Care. 2006; 12(5): 388–394. DOI: 10.1097/01.ccx.0000244115.24000.f5
  16. Koh G.C.H., Chen C.H., Petrella R., Thind A. Rehabilitation impact indices and their independent predictors: A systematic review. BMJ Open.2013. DOI:10.1136/bmjopen-2013-003483
  17. Реабилитация винтенсивной терапии. Клинические рекомендации. Анестезиология иреаниматология. Под ред. И.Б. Заболотских и Е.М. Шифмана. М.: ГЭОТАР-медиа, 2016: 833–858.[Reabilitatsiya v intensivnoi terapii. Klinicheskie rekomendatsii. Anesteziologiya i reanimatologiya. Pod red. I.B. Zabolotskikh i E.M. Shifmana. M.: GEOTAR-media, 2016: 833–858. (In Russ)]
  18. Мельникова Е.В., Шмонин А.А., Мальцева М.Н., Иванова Г.Е. Модифицированная шкала Рэнкина — универсальный инструмент оценки независимости и инвалидизации пациентов в медицинской реабилитации. Consilium Medicum. 2017; 19(2.1): 8–13. [Melnikova E.V., Shmonin A.A., Maltseva M.N., Ivanova G.E. The modified Rankin scale is a universal tool for assessment the independence and disability of patients in medical rehabilitation. Consilium Medicum. 2017; 19(2.1): 8–13. (In Russ)]
  19. Pronovost P.J., Miller M., Wachter R.M. The GAAP in quality measurement and reporting. J Am Med Assoc. 2007. DOI: 10.1001/jama.298.15.1800
  20. Parry S.M., Huang M., Needham D.M. Evaluating physical functioning in critical care: Considerations for clinical practice and research. Crit Care. 2017. DOI: 10.1186/s13054-017-1827-6
  21. Turner-Stokes L., Williams H., Bill A., et al. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: A multicentre cohort analysis of a national clinical data set. BMJ Open. 2016. DOI: 10.1136/bmjopen-2015-010238
  22. Kang E.Y., Jee S.J., Kim C.S., et al. The feasibility study of Computer Cognitive Senior Assessment System-Screen (CoSAS-S) in critically ill patients with sepsis. J Crit Care. 2018; 44: 128–133. DOI: 10.1016/j.jcrc.2017.10.005
  23. Cher E.W.L., Tay K.S., Zhang K., et al. The Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study. Geriatr Orthop Surg Rehabil. 2018; 9: 215145931876950. DOI: 10.1177/2151459318769508
  24. Abdul-Sattar A.B., Godab T. Predictors of functional outcome in Saudi Arabian patients with stroke after inpatient rehabilitation. NeuroRehabilitation. 2013; 33(2): 209–216. DOI: 10.3233/NRE-130947
  25. Udekwu P., Kromhout-Schiro S., Vaslef S., et al. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma — Inj Infect Crit Care. 2004; 56(5): 1084–1089. DOI: 10.1097/01.TA.0000124283.02605.A5
  26. Heinz U.E., Rollnik J.D. Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation Neurology. BMC Res Notes. 2015; 8(1). DOI: 10.1186/s13104-015-1175-z
  27. Perme C., Nawa R.K., Winkelman C., Masud F. A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score. Methodist Debakey Cardiovasc J. 2014; 10(1): 41–49. DOI: 10.14797/mdcj-10-1-41
  28. Оганов Р.Г., Денисов И.Н., Симаненков В.И. и др. Коморбидная патология в клинической практике. Клинические рекомендации. Кардиоваскулярная терапия и профилактика. 2017; 16(6): 5–56. DOI: 10.15829/1728-8800-2017-6-5-56. [Oganov R.G., Denisov I.N., Simanenkov V.I. et al. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017; 16(6): 5–56. (In Russ)]
  29. Hodgson C.L., Capell E., Tipping C.J. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice. In: Vincent J.L. (eds) Annual Update in Intensive Care and Emergency Medicine. Springer, Cham; 2018: 621–632. DOI: 10.1007/978-3-319-73670-9_46
  30. Pfoh E.R., Wozniak A.W., Colantuoni E., et al. Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study. Intensive Care Med. 2016; 42(10): 1557–1566. DOI: 10.1007/s00134-016-4530-1
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