Comparison of early and delayed rehabilitation outcomes in patients at the intensive care unit

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OBJECTIVE

To evaluate an efficacy and safety of rehabilitation in intensive care unit (ICU) depending on the time of rehabilitation onset.

MATERIAL AND METHODS

The study included data of 148 patients (106 patients with sepsis and postoperative complications and 42 patients with acute brain impairment) who received daily rehabilitation treatment for at least 7 days at the ICU for the period from 2017 to 2019. All patients were retrospectively assigned to the group of early rehabilitation (ER), if rehabilitation treatment was started within 48 hours after admission to ICU. The group of delayed rehabilitation (DR) included instable patients and those with impossible early mobilization.

RESULTS

Baseline clinical and demographic characteristics were similar in both groups. Incidence of infectious complications and vasopressor support was also comparable throughout rehabilitation. Duration of mechanical ventilation in patients without acute brain impairment was 8 (6) days in the ER group and 13 (9) days in the DR group (p=0.003). ICU-stay in the same category of patients was longer in the DR group compared to the ER group (19 (13—30) and 12 (9—16) days, respectively; p<0.001); hospital-stay was 31 (13) and 23 (12) days, respectively (p=0.005). In patients with acute brain impairment, incidence of delirium (p=0.024) and depression (p=0.040) was lower in the ER group. Mortality and the incidence of major complications were comparable in both groups.

CONCLUSION

The earliest onset of rehabilitation reduces duration of respiratory support and hospital-stay. In patients with acute cerebral insufficiency, this approach reduces the incidence of delirium and depression.

Keywords:

early rehabilitation

ICU

post-intensive care syndrome

Authors:

Andreychenko S.A.

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies

Serezhechkin A.V.

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies

Bychinin M.V.

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies

SPIN RSCI: 6524-9947
Scopus AuthorID: 57221999178
ORCID: 0000-0001-8461-4867

Klypa T.V.

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies

SPIN RSCI: 2349-8980
Scopus AuthorID: 22835146300
ORCID: 0000-0002-2732-967X

Received:

12.06.2020

Accepted:

07.07.2020

List of references:

Denehy L, Lanphere J, Needham DM. Ten reasons why ICU patients should be mobilized early. Intensive Care Medicine. 2016;43(1):86-90. https://doi.org/10.1007/s00134-016-4513-2
Titova EYu, Nechaev DS, Prudnikov NS, Svetogor AA, Tsvetkov DS, Laktionova LV. Role of early mobilization in the combination treatment of intensive care unit patients. Vestnik anesteziologii i reanimatologii. 2014;3:52-59. (In Russ.).
Fukawa Y, Kakuda W, Yoshida S, Zenta M, Itano O, Kiko R, Tani H, Kubo A. Clinical Impact of the Introduction of an Early Rehabilitation Protocol on Infectious Complications in Patients after Gastrointestinal Cancer Surgery. Progress in Rehabilitation Medicine [Internet]. Japanese Association of Rehabilitation Medicine; 2019;4. https://doi.org/10.2490/prm.20190005
Parry SM, Berney S, Warrillow S, El-Ansary D, Bryant AL, Hart N, Puthucheary Z, Koopman R, Denehy L. Functional electrical stimulation with cycling in the critically ill: A pilot case-matched control study. Journal of Critical Care. 2014;29(4):695.e1-695.e7. https://doi.org/10.1016/j.jcrc.2014.03.017
Hamilton M, Tomlinson G, Chu L, Robles P, Matte A, Burns S, Thomas C, Lamontagne F, Adhikari NKJ, Ferguson N, Friedrich JO, Rudkowski JC, Skrobik Y, Meggison H, Cameron J, Herridge M; RECOVER Program Investigators; Canadian Critical Care Trials Group. Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥7 Days of Mechanical Ventilation. Chest. 2019;156(3):466-476. https://doi.org/10.1016/j.chest.2019.04.104
Gruther W, Pieber K, Steiner I, Hein C, Hiesmayr JM, Paternostro-Sluga T. Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness? Ame-rican Journal of Physical Medicine and Rehabilitation. 2017;96(9):607-615. https://doi.org/10.1097/phm.0000000000000718
Ding N, Zhang Z, Zhang C, Yao L, Yang L, Jiang B, Wu Y, Jiang L, Tian J. What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis. PloS One 2019;14(10):e0223151. https://doi.org/10.1371/journal.pone.0223151
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, Hopkinson NS, Phadke R, Dew T, Sidhu PS, Velloso C, Seymour J, Agley CC, Selby A, Limb M, Edwards LM, Smith K, Rowlerson A, Rennie MJ, Moxham J, Harridge SD, Hart N, Montgomery HE. Acute Skeletal Muscle Wasting in Critical Illness. JAMA. 2013;310(15):1591-1600. https://doi.org/10.1001/jama.2013.278481
Okuda Y, Nakata T. Effect of intensive rehabilitation on improvement of activity of daily living after intracerebral hemorrhage. International Journal of Rehabilitation Research. 2020;43(1):37-40. https://doi.org/10.1097/mrr.0000000000000381
Fan MC, Li SF, Sun P, Bai GT, Wang N, Han C, Sun J, Li Y, Li HT. Early Intensive Rehabilitation for Patients with Traumatic Brain Injury: A Prospective Pilot Trial. World Neurosurgery. 2020;137:183-188. https://doi.org/10.1016/j.wneu.2020.01.113
Greening NJ, Williams JE, Hussain SF, Harvey-Dunstan TC, Bankart MJ, Chaplin EJ, Vincent EE, Chimera R, Morgan MD, Singh SJ, Steiner MC. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ. BMJ. 2014;349:4315. https://doi.org/10.1136/bmj.g4315
von Bornstädt D, Houben T, Seidel JL, Zheng Y, Dilekoz E, Qin T, Sandow N, Kura S, Eikermann-Haerter K, Endres M, Boas DA, Moskowitz MA, Lo EH, Dreier JP, Woitzik J, Sakadžić S, Ayata C. Supply-Demand Mismatch Transients in Susceptible Peri-infarct Hot Zones Explain the Origins of Spreading Injury Depolarizations. Neuron. 2015;85(5):1117-1131. https://doi.org/10.1016/j.neuron.2015.02.007
Reabilitatsiya v intensivnoi terapii. Klinicheskie rekomendatsii. Anesteziologiya i reanimatologiya. Pod red. Zabolotskikh I.B. i Shifmana E.M. M.: GEOTAR-Media; 2016. (In Russ.).
Wright SE, Thomas K, Watson G, Baker C, Bryant A, Chadwick TJ, Shen J, Wood R, Wilkinson J, Mansfield L, Stafford V, Wade C, Furneval J, Henderson A, Hugill K, Howard P, Roy A, Bonner S, Baudouin S. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2017;73(3):213-321. https://doi.org/10.1136/thoraxjnl-2016-209858
Hodgson CL, Capell E, Tipping CJ. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice. In: Vincent JL. (eds) Annual Update in Intensive Care and Emergency Medicine. Springer, Cham; 2018;621-632. https://doi.org/10.1007/978-3-319-73670-9_46
Moss M, Nordon-Craft A, Malone D, Van Pelt D, Frankel SK, Warner ML, Kriekels W, McNulty M, Fairclough DL, Schenkman M. A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure. American Journal of Respiratory and Critical Care Medicine. 2016;193(10):1101-1110. https://doi.org/10.1164/rccm.201505-1039oc
Hsieh SJ, Otusanya O, Gershengorn HB, Hope AA, Dayton C, Levi D, Garcia M, Prince D, Mills M, Fein D, Colman S, Gong MN. Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs. Critical Care Medicine. 2019;47(7):885-893. https://doi.org/10.1097/ccm.0000000000003765
Wolters AE, Peelen LM, Welling MC, Kok L, de Lange DW, Cremer OL, van Dijk D, Slooter AJ, Veldhuijzen DS. Long-Term Mental Health Problems after Delirium in the ICU. Critical Care Medicine. 2016;44(10):1808-1813. https://doi.org/10.1097/ccm.0000000000001861
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, Heim M, Houle T, Kurth T, Latronico N, Lee J, Meyer MJ, Peponis T, Talmor D, Velmahos GC, Waak K, Walz JM, Zafonte R, Eikermann M; International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377-1388. https://doi.org/10.1016/s0140-6736(16)31637-3
Zivi I, Valsecchi R, Maestri R, Maffia S, Zarucchi A, Molatore K, Vellati E, Saltuari L, Frazzitta G. Early Rehabilitation Reduces Time to Decannulation in Patients With Severe Acquired Brain Injury: A Retrospective Study. Frontiers in Neurology. 2018;9:559. https://doi.org/10.3389/fneur.2018.00559
Avert Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. The Lancet. 2015;386(9988):46-55. https://doi.org/10.1016/s0140-6736(15)60690-0
Tong Y, Cheng Z, Rajah GB, Duan H, Cai L, Zhang N, Du H, Geng X, Ding Y. High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke. Frontiers in Neurology. 2019;10:113. https://doi.org/10.3389/fneur.2019.00113
Truijen J, Rasmussen LS, Kim YS, Stam J, Stok WJ, Pott FC, van Lieshout JJ. Cerebral autoregulatory performance and the cerebrovascular response to head-of-bed positioning in acute ischaemic stroke. European Journal of Neurology. 2018;25(11):1365-e117. https://doi.org/10.1111/ene.13737
Li F, Pendy JT, Ding JN, Peng C, Li X, Shen J, Wang S, Geng X. Exercise rehabilitation immediately following ischemic stroke exacerbates inflammatory injury. Neurological Research. 2017;39(6):530-537. https://doi.org/10.1080/01616412.2017.1315882

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