Design and Study Subjects
This survey was designed as a single-center retrospective cohort study. Subjects were survivors who were admitted to Nagasaki University Hospital from April 2016 to March 2017 and stayed in the intensive care unit run by intensivists. The inclusion criteria were a stay in intensive care > 48 h, age ≥ 18 years and physiotherapy. We excluded patients with inability to walk prior to ICU admission, complications of neuromuscular disease and amputation, left ventricular assist device implantation, lung transplantation and treated with oxygenation by extracorporeal membrane and intra-aortic balloon pump.
Baseline patient characteristics prior to ICU admission regarding age, sex, height, weight, body mass index, diagnosis, Charlson Comorbidity Index (CCI), and therapy continuous renal replacement therapy (CRRT) were collected from medical records, and subjects’ ADLs were assessed using the Eastern Cooperative Oncology Group (ECOG-PS) performance status and Katz. Although ECOG-PS is typically used for cancer patients, its usefulness as a prognostic value for general critically ill patients at preadmission has also been reported.20. At ICU admission, the Sequential Organ Failure Assessment (SOFA) score, catecholamine index (dopamine + dobutamine + (epinephrine + norepinephrine) × 100 μg/kg/min), was assessed . During ICU stay, details regarding complications of sepsis, treatment of CRRT and mechanical ventilation, presence of surgery and enteral nutrition, blood parameters (albumin, lactate and protein C -reactive), the period of sedation and the length of stay in intensive care were collected from physicians. recordings. At hospital discharge, ECOG-PS, Katz Index, and in-hospital DS were collected from medical records.
ADL Assessment Tool
The Eastern Cooperative Oncology Group performance status rating was defined as: 0, fully active, able to perform all pre-illness activities without restriction; 1, limited in strenuous physical activities but ambulatory and able to perform work of a light or sedentary nature; 2, ambulatory and able to care for himself, but unable to perform occupational activities, as well as standing for approximately > 50% of waking hours; 3, capable of limited self-care, confined to bed or chair for >50% of waking hours; and 4, completely disabled, unable to care for himself, totally confined to bed or chair21. The Katz Index classifies performance adequacy into the six functions of bathing, dressing, grooming, transferring, continence, and feeding. Patients are scored on a yes/no basis for independence in each of the six functions. A score of 6 indicates full functioning, 4 indicates moderate impairment, and ≤ 2 indicates severe functional impairment22.
The sedation period was defined as the number of days that the Richmond Agitation and Sedation Scale score was 23.
Mobilization was performed according to a previously reported protocol24. We defined early mobilization as level sitting on the edge of the bed or higher, as applicable to 3 in the Intensive Care Mobility Scale (IMS), within the first 2 days during the patients’ stay in the ICU.25. Details regarding the first day of intervention, sitting on the edge of the bed (IMS = 3), standing (IMS = 4), and gait (IMS ≥ 7) were collected from medical records.
Regression analysis was performed to identify clinical variables associated with sedation period as a continuous variable. Candidate factors were selected based on a review of the literature, clinical expertise, and those that contributed significantly to the outcome of the single linear regression analysis (p 26. These models were applied to assess whether these variables were the predictors of the sedation period for the subjects. In addition, we performed three sub-analyses. First, the SOFA threshold score for determining the period of sedation for ≥3 days was assessed using a Receiver Operating Characteristic (ROC) curve. The highest value of the Youden index was used as the criterion for determining the threshold. Second, Spearman’s rank correlation coefficient was calculated to determine whether sedation period correlated with early mobilization progression. Third, Wilcoxon’s rank sum test was used to examine differences in sedation period due to changes in ADLs as changes in ECOG-PS and Katz’s index at discharge. hospital compared to baseline. No subject showed improvement in ADLs. We divided the subjects into two groups, the preservation group which maintained the ECOG-PS score and Katz index at discharge from baseline and the decrease group which decreased its score. All analyzes were performed using the JMP® pro 13 software, version 13.0.0 (SAS Institute Inc., Cary, NC, USA). Data are expressed as median (25th to 75th percentile) or percentage, as appropriate. The level of significance was 0.05 for all tests.
This study was approved by the Human Ethics Review Board of Nagasaki University Hospital (reference number 19070826). Informed consent for the analysis and publication of data in this study was waved by the Human Ethics Review Board of Nagasaki University Hospital and was obtained in the form of an opt-out on the website. Those who refused were excluded. This study was conducted in accordance with the Declaration of Helsinki.
Consent to publication
The research poses only a minimal risk of harm to the subjects and does not involve any procedure; therefore, the requirement for written consent has been waived.