Patients undergoing cardiac surgery can experience functional impairment.
Assess the influence of Perme Score on the intensive care unit (ICU) length of stay in patients after cardiac surgery. As a ...secondary objective, investigate if preoperative variables can predict the patient's mobility status after surgery.
A prospective observational study was conducted in ICU in a university hospital. The mobility status (Perme Score) was collected from the first postoperative day until ICU discharge. The preoperative assessment of respiratory muscle strength, pulmonary function, and handgrip strength were collected.
A total of 44 patients, mean age of 62.3 years, 28 men were included in the study. A high Perme Score on the second postoperative day among patients who underwent Coronary artery bypass grafting and the third postoperative day on three types of intervention (Coronary artery bypass grafting, valve replacement, or both simultaneously) was associated with shorter ICU length of stay). The preoperative pulmonary function was one of the main independent predictors of mobility status on the first three days of ICU stay, in addition to left ventricular ejection fraction and cardiopulmonary bypass time on the first day, age, and left ventricular ejection fraction on the second day and maximum expiratory pressure on third day.
An increase in mobility status (Perme Score), mainly on the third postoperative day, reduced the ICU stay, mainly influenced by preoperative pulmonary function.
The scales to measure functional mobility in critically ill patients were developed and validated in English, there is a need for these tools in Spanish speaking countries.
To perform translation, ...cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Intensive Care Unit Mobility Score and IMS tools in ICU patients.
Translation and validation study between November 2016 and July 2017, following the COSMIN Protocol's recommendations. Two couples of physiotherapists with the role of observer/rater applied both scales in 150 patients upon admission and discharge of a medical-surgical ICU from a private hospital in Colombia. The sample size was defined taking into account the lowest proportion of reported agreement (68.57%), a Kappa index of 0.2784 or higher to ensure that the calculated n was adequate, and a confidence level of 95.
Translation and cultural adaptation were performed, the final version of both scales in Spanish was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 63 (42%) of the cases. Inter-rater reliability of the ICU Mobility Scale was between 0.97 and 1.00, and for the Perme Intensive Care Unit the Mobility Score it was between 0.99 and 1 in the two moments of the measurements.
Both scales were translated and culturally adapted and presented excellent inter-rater reliability in the two pairs of raters (rater/observer).
The Coronavirus Disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. Data on the mobility level of patients with COVID-19 in the intensive care unit (ICU) are needed. To describe the ...mobility level of patients with COVID-19 admitted to the ICU and to address factors associated with mobility level at the time of ICU discharge. Single center, retrospective cohort study. Consecutive patients admitted to the ICU with confirmed COVID-19 infection were analyzed. The mobility status was assessed by the Perme Score at admission and discharge from ICU with higher scores indicating higher mobility level. The Perme Mobility Index (PMI) was calculated PMI = DELTAPerme Score (ICU discharge-ICU admission)/ICU length of stay. Based on the PMI, patients were divided into two groups: "Improved" (PMI > 0) and "Not improved" (PMI less than or equal to 0). A total of 136 patients were included in this analysis. The hospital mortality rate was 16.2%. The Perme Score improved significantly when comparing ICU discharge with ICU admission 20.0 (7-28) points versus 7.0 (0-16) points; P < 0.001. A total of 88 patients (64.7%) improved their mobility level during ICU stay, and the median PMI of these patients was 1.5 (0.6-3.4). Patients in the improved group had a lower duration of mechanical ventilation 10 (5-14) days versus 15 (8-24) days; P = 0.021, lower hospital length of stay 25 (12-37) days versus 30 (11-48) days; P < 0.001, and lower ICU and hospital mortality rate. Independent predictors for mobility level were lower age, lower Charlson Comorbidity Index, and not having received renal replacement therapy.
Abstract Background Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities. Objective To assess the worldwide use of validated delirium assessment ...tools and the presence of delirium management protocols. Design Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023. Setting Cross-sectional online survey including hospitals, rehabilitation and long-term facilities. Methods Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers. Results Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol n = 1094/1664, 66.8% were more likely to use a validated delirium test than those without a protocol odds ratio 6.97 (95% confidence interval 5.289–9.185). The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions. Conclusion Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.
The benefits of early mobilization for adult patients in the intensive care unit (ICU) are reduced length of ICU and hospital stays, fewer readmissions to the ICU, decreased duration of mechanical ...ventilation, fewer days of detrimental bedrest, minimal adverse or unsafe events, and improved walking distance. Because there are no available tools to specifically measure mobility status of patients in the ICU setting, there is an urgent need to create a reliable tool that measures and standardizes the assessment of mobility status for these patients. The purpose of this study was to describe the development of this novel ICU-specific tool to assess a patient's mobility status, examine the initial reliability of the tool, and address its clinical application. The Perme ICU Score was quickly and easily administered by physical therapists. Overall, the inter-rater agreement was 94%. A total of six items had kappa values of < .6, and these low scores may have been the result of the procedure to collect inter-rater scores, wherein one rater assisted with the activity while a second rater observed. In order to improve reliability, the authors developed directions to standardize the assessment. The Perme ICU Mobility Score is a tool developed to measure the patient's mobility status starting with the ability to follow commands and culminating in the distance walked in two minutes. Preliminary data suggest that the validity of this tool is supported by expert concurrence, its overall reliability is high, and its clinical use is acceptable.
Oxygen is the most common drug used in critical care patients to correct episodes of hypoxaemia. The adoption of new technologies in clinical practice, such as closed-loop systems for an automatic ...oxygen titration, may improve outcomes and reduce the healthcare professionals' workload at the bedside; however, certainty of the evidence regarding the safety and benefits still remains low. We aim to evaluate the effectiveness, efficacy and safety of the closed-loop oxygen control for patients with hypoxaemia during the hospitalisation period by conducting a systematic review and meta-analysis.
MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL and LOVE evidence databases will be searched. Randomised controlled trials and cross-over studies investigating the PICO (Population, Intervention, Comparator and Outcome) framework will be included. The primary outcomes will be the time in the peripheral oxygen saturation target. Secondary outcomes will include time for oxygen weaning time; length of stay; costs; adverse events; mortality; healthcare professionals' workload, and percentage of time with hypoxia and hyperoxia. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. The RevMan V.5.4 software will be used for statistical analysis. Heterogeneity will be analysed using I
statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables.
Ethical approval is not required because this systematic review and meta-analysis is based on previously published data. Final results will be published in peer-reviewed journals and presented at relevant conferences and events.
CRD42022306033.
There are limited data describing mobility interventions provided to patients with femoral catheters. The purpose of this study was to examine the incidence of femoral catheter related adverse ...effects during physical therapy (PT) sessions in a cardiovascular intensive care unit (ICU).
This was a prospective, observational study and included patients with at least one femoral catheter. Data were collected after each PT session.
There were 77 subjects with a total of 92 femoral catheters (50 arterial, 15 central venous, and 27 dialysis) treated. A total of 210 separate PT sessions occurred with 630 mobility activities including sitting on side of bed, standing at the bedside, transfers to stretcher chair or regular chair, and walking. There were no catheter related mechanical or thrombotic complications during any of the PT sessions.
Physical therapy sessions, including standing and walking were feasible and safe in cardiovascular ICU patients with femoral catheters who met the criteria for mobility interventions. The results from this study support the hypothesis that early mobilization in patients with femoral catheters is important to minimize functional decline and provide evidence that the presence of femoral catheters alone should not be a reason to limit progressive mobility interventions.
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