Authors (including presenting author) :
Lee WWY(1), Lam CPY(1) , Ko LKY(1), Uy JCH(1), Liu YM(1), Chao CYL(1), So DHK(2), Kandamby DH(2), Lee YK(2), Leung WS(2), Leung CYY(1)
Affiliation :
(1) Physiotherapy Department, Princess Margaret Hospital, (2) Intensive Care Unit, Princess Margaret Hospital
Introduction :
Intensive care unit-acquired weakness (ICUAW), characterized by generalized limb and respiratory muscle weakness, is a common complication among critically ill mechanically ventilated patients. Early mobilization (EM) has been reported to be safe and effective in counteracting ICUAW. Among all EM exercises, out-of-bed mobilization, ranging from sitting at bed edge to standing and walking, is of utmost significance as the exercise challenges the cardiovascular, respiratory and musculoskeletal systems. An EM program has been conducted by physiotherapists in collaboration with medical and nursing teams in the ICU of the Princess Margaret Hospital (PMH) since 2020.
Objectives :
This retrospective study aims to compare the clinical outcomes for critically ill patients who received in-bed and out-of-bed EM training at the ICU.
Methodology :
Data of critically ill patients discharged from hospital in the period of April 2023 to March 2024, with a stay in PMH ICU, were retrieved for analysis. Demographic data and clinical outcomes on ICU Mobility Scale (ICUMS), a measure of critically ill patients' mobility milestones, and the Medical Research Council-Sum Score (MRCSS), a diagnostic tool for ICUAW, at the initial and final sessions of ICU stay were compared. The total number of sessions of in-bed and out-of-bed EM exercises, hospital length of stay (LOS) and discharge destinations were also evaluated.
Result & Outcome :
In the study period, 1,183 patients received ICU EM training by physiotherapist, of which 734 (60%) were male patients. The mean age was 61.7 years. The majority of them were from Surgery (41.2%) and Medicine (40.2%), followed by Orthopedics (9.0%), Neurosurgery (4.0%), and others (5.6%). A total of 3,825 EM sessions were delivered, and out-of-bed mobilization was administered in 710 sessions (18.6%). 41% of patients received at least one out-of-bed session of EM training. Upon discharge from ICU, the mean score of ICUMS improved significantly from 1.77 to 3.21 (p<0.001) and mean MRCSS from 45.6 to 47.25 (p<0.001). Subgroup analysis showed that patients who underwent out-of-bed mobilization exhibited more improvements, with mean changes of 3.12 in ICUMS and 2.18 in MRCSS, surpassing individuals who received solely in-bed exercises (Mean ICUMS +0.1; Mean MRCSS +0.96) (p<0.001). Additionally, the averaged hospital LOS for patients who received out-of-bed exercises was 34.07 days, which was statistically significantly lower than 47.81 days for those receiving in-bed mobilization only (p<0.001). Chi-square test of independence indicated that patients who received out-of-bed exercises were more likely to experience direct home discharge compared to those received in-bed exercises (p=0.023).
The preliminary findings demonstrated that ICU EM program could improve mobility and reduce the chance of acquiring ICUAW. While premorbid functional status and disease nature may impact patients’ eligibility for in-bed or out-of-bed exercise, the latter is associated with greater improvement in mobility and muscle power, as well as a shorter hospital LOS and more likelihood of direct home discharge.
