Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

American Journal of Critical Care Pub Date : 2024-09-01 DOI:10.4037/ajcc2024939

Anna E Krupp, Alai Tan, Eduard E Vasilevskis, Lorraine C Mion, Brenda T Pun, Audrey Brockman, Breanna Hetland, E Wesley Ely, Michele C Balas

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引用次数: 0

Abstract

Background: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied.

Objectives: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance.

Methods: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated.

Results: In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01-1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59-1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14-2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04-2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30-1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39-0.49), delirium (AOR, 0.63; 95% CI, 0.59-0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79-0.92), physical restraints (AOR, 0.74; 95% CI, 0.68-0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68-0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance.

Conclusions: Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance.

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与重症成人早期行动能力相关的患者、实践和组织因素。

背景：在重症监护室（ICU）的实践中，早期移动能力干预措施的采用一直很缓慢，而且各不相同：研究与成人重症患者早期行动能力表现相关的因素，并评估这些因素对预测次日早期行动能力表现的影响：方法：对66所重症监护病房中至少入院24小时的患者数据进行二次分析。方法：对66个重症监护病房中至少住院24小时的患者数据进行二次分析，建立混合效应逻辑回归模型，并计算接收者操作特征曲线下面积（AUC）：在 12 489 名患者中，与次日行动能力较高几率独立相关的因素包括：明显疼痛（调整后的几率比 [AOR]，1.16；95% CI，1.09-1.23）、有记录的镇静目标（AOR，1.09；95% CI，1.01-1.18）、自发苏醒（AOR，1.09；95% CI，1.01-1.18）。18）、自发唤醒试验（AOR，1.77；95% CI，1.59-1.96）、自发呼吸试验（AOR，2.35；95% CI，2.14-2.58）、行动安全筛查（AOR，2.26；95% CI，2.04-2.49）和前一天的物理/职业治疗（AOR，1.44；95% CI，1.30-1.59）。与次日行动能力降低几率独立相关的因素包括深度镇静（AOR，0.44；95% CI，0.39-0.49）、谵妄（AOR，0.63；95% CI，0.59-0.69）、苯二氮卓类药物用药（AOR，0.85；95% CI，0.79-0.92）、物理约束（AOR，0.74；95% CI，0.68-0.80）和机械通气（AOR，0.73；95% CI，0.68-0.78）。黑人和西班牙裔患者次日移动的几率低于其他患者。在预测次日早期移动能力表现方面，包含患者、实践和单位间差异的模型显示出较高的判别准确性（AUC，0.853）：综合来看，一些可改变和不可改变的因素可以很好地预测次日的早期行动能力表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Critical Care 医学-护理

CiteScore

4.30

自引率

3.70%

发文量

103

审稿时长

6-12 weeks

期刊介绍： The editors of the American Journal of Critical Care (AJCC) invite authors to submit original manuscripts describing investigations, advances, or observations from all specialties related to the care of critically and acutely ill patients. Papers promoting collaborative practice and research are encouraged. Manuscripts will be considered on the understanding that they have not been published elsewhere and have been submitted solely to AJCC.