C Christopher Zalesky, Katelyn Whitlock, Briana Krieger, Jennifer J Sharp, Emily D Geyer, Sagar Dave, David W Boorman, Christina Creel-Bulos
{"title":"跳上去！物理治疗时间和频率与体外膜氧合患者功能结局的关系：一项单中心回顾性研究。","authors":"C Christopher Zalesky, Katelyn Whitlock, Briana Krieger, Jennifer J Sharp, Emily D Geyer, Sagar Dave, David W Boorman, Christina Creel-Bulos","doi":"10.1097/CCE.0000000000001307","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Physical therapy (PT) interventions for patients supported with extracorporeal membrane oxygenation (ECMO) is thought to help preserve independence, but the impact of PT frequency on ECMO recovery is not well understood.</p><p><strong>Objectives: </strong>To explore the relationship between PT frequency and functional outcomes in patients supported with ECMO.</p><p><strong>Design, setting, and participants: </strong>Retrospective, single-center study of patients supported with ECMO at a large volume ECMO referral center. Patients were grouped by PT frequency (high < 3 d, moderate 3-7 d, and low > 7 d between sessions).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) \"6-Clicks\" Basic Mobility Score. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient's odds of a final AM-PAC score greater than or equal to 18, indicating functional independence.</p><p><strong>Results: </strong>One hundred forty-two subjects were included with a median age of 48 years (interquartile range, 35-58 yr). Patients received venovenous (55%, n = 78/142) or venoarterial (45%, n = 64/142) ECMO. Of the cohort, 61% (n = 86/142) were discharged alive. A final AM-PAC score of greater than or equal to 18 was seen in 30% of patients (n = 43/142) before discharge. High- and moderate-frequency groups were more likely to survive to hospital discharge (76%, n = 22/29 and 75%, n = 38/51 vs. 44%, n = 27/62; p = 0.001). Controlling for age, sex, PT frequency, and the number of PT sessions after ECMO, logistic regression showed the number of PT sessions on ECMO (odds ratio, 1.13; 95% CI, 1.02-1.28) significantly impacted the odds of a final AM-PAC score greater than or equal to 18.</p><p><strong>Conclusions and relevance: </strong>In patients supported with ECMO, high- and moderate-frequency of PT and PT on ECMO were associated with improved functional outcomes at hospital discharge.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 9","pages":"e1307"},"PeriodicalIF":2.7000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431764/pdf/","citationCount":"0","resultStr":"{\"title\":\"Jump On It! 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Patients were grouped by PT frequency (high < 3 d, moderate 3-7 d, and low > 7 d between sessions).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) \\\"6-Clicks\\\" Basic Mobility Score. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient's odds of a final AM-PAC score greater than or equal to 18, indicating functional independence.</p><p><strong>Results: </strong>One hundred forty-two subjects were included with a median age of 48 years (interquartile range, 35-58 yr). Patients received venovenous (55%, n = 78/142) or venoarterial (45%, n = 64/142) ECMO. Of the cohort, 61% (n = 86/142) were discharged alive. A final AM-PAC score of greater than or equal to 18 was seen in 30% of patients (n = 43/142) before discharge. High- and moderate-frequency groups were more likely to survive to hospital discharge (76%, n = 22/29 and 75%, n = 38/51 vs. 44%, n = 27/62; p = 0.001). Controlling for age, sex, PT frequency, and the number of PT sessions after ECMO, logistic regression showed the number of PT sessions on ECMO (odds ratio, 1.13; 95% CI, 1.02-1.28) significantly impacted the odds of a final AM-PAC score greater than or equal to 18.</p><p><strong>Conclusions and relevance: </strong>In patients supported with ECMO, high- and moderate-frequency of PT and PT on ECMO were associated with improved functional outcomes at hospital discharge.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":\"7 9\",\"pages\":\"e1307\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431764/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001307\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001307","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
重要性：对于体外膜氧合（ECMO）支持的患者，物理治疗（PT）干预被认为有助于保持独立性，但PT频率对ECMO恢复的影响尚不清楚。目的：探讨体外膜肺栓塞（ECMO）患者PT频率与功能结局的关系。设计、环境和参与者：回顾性、单中心研究在大容量ECMO转诊中心支持ECMO的患者。患者按PT频率分组（高< 3天，中等3-7天，低bbb7天）。主要结局和测量：主要结局是急性期后护理活动测量（AM-PAC）“6次点击”基本活动能力评分。对于存活出院的患者亚组，使用多变量逻辑模型来了解影响患者最终AM-PAC评分大于或等于18的几率的因素，这表明功能独立性。结果：纳入142名受试者，中位年龄为48岁（四分位数范围为35-58岁）。患者接受静脉静脉（55%,n = 78/142）或静脉动脉（45%,n = 64/142） ECMO。在该队列中，61% （n = 86/142）存活出院。30%的患者（n = 43/142）在出院前最终AM-PAC评分大于或等于18。高、中频组存活至出院的可能性更高（76%,n = 22/29; 75%, n = 38/51; 44%, n = 27/62; p = 0.001）。控制年龄、性别、PT频率和ECMO后PT次数后，逻辑回归显示ECMO上PT次数（优势比为1.13；95% CI为1.02-1.28）显著影响最终AM-PAC评分大于或等于18的几率。结论和相关性：在ECMO支持的患者中，高频率和中等频率的PT和ECMO上的PT与出院时功能预后的改善相关。
Jump On It! The Association of Physical Therapy Timing and Frequency With Functional Outcomes in Patients Supported With Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study.
Importance: Physical therapy (PT) interventions for patients supported with extracorporeal membrane oxygenation (ECMO) is thought to help preserve independence, but the impact of PT frequency on ECMO recovery is not well understood.
Objectives: To explore the relationship between PT frequency and functional outcomes in patients supported with ECMO.
Design, setting, and participants: Retrospective, single-center study of patients supported with ECMO at a large volume ECMO referral center. Patients were grouped by PT frequency (high < 3 d, moderate 3-7 d, and low > 7 d between sessions).
Main outcomes and measures: The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Basic Mobility Score. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient's odds of a final AM-PAC score greater than or equal to 18, indicating functional independence.
Results: One hundred forty-two subjects were included with a median age of 48 years (interquartile range, 35-58 yr). Patients received venovenous (55%, n = 78/142) or venoarterial (45%, n = 64/142) ECMO. Of the cohort, 61% (n = 86/142) were discharged alive. A final AM-PAC score of greater than or equal to 18 was seen in 30% of patients (n = 43/142) before discharge. High- and moderate-frequency groups were more likely to survive to hospital discharge (76%, n = 22/29 and 75%, n = 38/51 vs. 44%, n = 27/62; p = 0.001). Controlling for age, sex, PT frequency, and the number of PT sessions after ECMO, logistic regression showed the number of PT sessions on ECMO (odds ratio, 1.13; 95% CI, 1.02-1.28) significantly impacted the odds of a final AM-PAC score greater than or equal to 18.
Conclusions and relevance: In patients supported with ECMO, high- and moderate-frequency of PT and PT on ECMO were associated with improved functional outcomes at hospital discharge.
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