Severe coronavirus disease 2019 (COVID-19) patients frequently require mechanical ventilation (MV) and undergo prolonged periods of bed rest with restriction of activities during the intensive care ...unit (ICU) stay. Our aim was to address the degree of mobilization in critically ill patients with COVID-19 undergoing to MV support. Retrospective single-center cohort study. We analyzed patients' mobility level, through the Perme ICU Mobility Score (Perme Score) of COVID-19 patients admitted to the ICU. The Perme Mobility Index (PMI) was calculated PMI = DELTAPerme Score (ICU discharge-ICU admission)/ICU length of stay, and patients were categorized as "improved" (PMI > 0) or "not improved" (PMI less than or equal to 0). Comparisons were performed with stratification according to the use of MV support. From February 2020, to February 2021, 1,297 patients with COVID-19 were admitted to the ICU and assessed for eligibility. Out of those, 949 patients were included in the study 524 (55.2%) were classified as "improved" and 425 (44.8%) as "not improved", and 396 (41.7%) received MV during ICU stay. The overall rate of patients out of bed and able to walk greater than or equal to 30 meters at ICU discharge were, respectively, 526 (63.3%) and 170 (20.5%). After adjusting for confounders, independent predictors of improvement of mobility level were frailty (OR: 0.52; 95% CI: 0.29-0.94; p = 0.03); SAPS III Score (OR: 0.75; 95% CI: 0.57-0.99; p = 0.04); SOFA Score (OR: 0.58; 95% CI: 0.43-0.78; p < 0.001); use of MV after the first hour of ICU admission (OR: 0.41; 95% CI: 0.17-0.99; p = 0.04); tracheostomy (OR: 0.54; 95% CI: 0.30-0.95; p = 0.03); use of extracorporeal membrane oxygenation (OR: 0.21; 95% CI: 0.05-0.8; p = 0.03); neuromuscular blockade (OR: 0.53; 95% CI: 0.3-0.95; p = 0.03); a higher Perme Score at admission (OR: 0.35; 95% CI: 0.28-0.43; p < 0.001); palliative care (OR: 0.05; 95% CI: 0.01-0.16; p < 0.001); and a longer ICU stay (OR: 0.79; 95% CI: 0.61-0.97; p = 0.04) were associated with a lower chance of mobility improvement, while non-invasive ventilation within the first hour of ICU admission and after the first hour of ICU admission (OR: 2.45; 95% CI: 1.59-3.81; p < 0.001) and (OR: 2.25; 95% CI: 1.56-3.26; p < 0.001), respectively; and vasopressor use (OR: 2.39; 95% CI: 1.07-5.5; p = 0.03) were associated with a higher chance of mobility improvement. The use of MV reduced mobility status in less than half of critically ill COVID-19 patients.
How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions?
Systematic review of randomised trials.
People with COVID-19 and post-COVID-19 conditions.
Any type ...of telerehabilitation.
Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and level of independence.
Database searches retrieved 2,962 records, of which six trials with 323 participants were included in the review. Breathing exercises delivered via telerehabilitation improved 6-minute walk distance (MD 101 m, 95% CI 61 to 141; two studies), 30-second sit-to-stand test performance (MD 2.2 repetitions, 95% CI 1.5 to 2.8; two studies), Multidimensional Dyspnoea-12 questionnaire scores (MD –6, 95% CI –7 to –5; two studies) and perceived effort on the 0-to-10 Borg scale (MD –2.8, 95% CI –3.3 to –2.3; two studies), with low certainty of evidence. Exercise delivered via telerehabilitation improved 6-minute walk distance (MD 62 m, 95% CI 42 to 82, four studies), 30-second sit-to-stand test performance (MD 2.0 repetitions, 95% CI 1.3 to 2.7; two studies) and Multidimensional Dyspnoea-12 scores (MD –1.8, 95% CI –2.5 to –1.1; one study), with low certainty of evidence. Adverse events were almost all mild or moderate and occurred with similar frequency in the telerehabilitation group (median 0 per participant, IQR 0 to 2.75) as in the control group (median 0 per participant, IQR 0 to 2); Hodges-Lehmann median difference 0 (95% CI 0 to 0), with low certainty of evidence.
Telerehabilitation may improve functional capacity, dyspnoea, performance and physical components of quality of life and does not substantially increase adverse events.
PROSPERO CRD42021271049.
The impact of closed-loop control systems to titrate oxygen flow in critically ill patients, including their effectiveness, efficacy, workload and safety, remains unclear. This systematic review ...investigated the utilization of closed-loop oxygen systems for critically ill patients in comparison to manual oxygen titration systems focusing on these topics. A search was conducted across several databases including MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, LOVE, ClinicalTrials.gov, and the World Health Organization on March 3, 2022, with subsequent updates made on June 27, 2023. Evidence databases were searched for randomized clinical parallel or crossover studies investigating closed-loop oxygen control systems for critically ill patients. This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The analysis was conducted using Review Manager software, adopting the mean difference or standardized mean difference with a 95% confidence interval (95% CI) for continuous variables or risk ratio with 95% CI for dichotomous outcomes. The main outcome of interest was the percentage of time spent in the peripheral arterial oxygen saturation target. Secondary outcomes included time for supplemental oxygen weaning, length of stay, mortality, costs, adverse events, and workload of healthcare professional. A total of 37 records from 21 studies were included in this review with a total of 1,577 participants. Compared with manual oxygen titration, closed-loop oxygen control systems increased the percentage of time in the prescribed SpO.sub.2 target, mean difference (MD) 25.47; 95% CI 19.7, 30.0, with moderate certainty of evidence. Current evidence also shows that closed-loop oxygen control systems have the potential to reduce the percentage of time with hypoxemia (MD -0.98; 95% CI -1.68, -0.27) and healthcare workload (MD -4.94; 95% CI -7.28, -2.61) with low certainty of evidence. Closed-loop oxygen control systems increase the percentage of time in the preferred SpO.sub.2 targets and may reduce healthcare workload.
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 = ΔPerme 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 ≤ 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.
Patients' mobility level was low at ICU admission; however, most patients improved their mobility level during ICU stay. Risk factors associated with the mobility level were age, comorbidities, and use of renal replacement therapy.
To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the ...interobserver agreement and reliability for both versions.
The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test.
The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement ( > 0.90) and reliability ( > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (-0.048 ± 0.350 and -0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from -0.73 to 0.64 and -1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001).
In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.
Realizar a tradução e a validação cultural para a língua portuguesa falada no Brasil e determinar a concordância e a confiabilidade dos instrumentos Perme Intensive Care Unit Mobility Score (designado Perme Escore) e ICU Mobility Scale (designada Escala de Mobilidade em UTI, EMU).
Os processos de tradução e adaptação cultural seguiram as seguintes etapas: preparação, tradução, reconciliação, síntese, tradução reversa, revisão, aprovação e pré-teste. Após esses processos, as versões em português dos dois instrumentos foram utilizadas por dois pesquisadores na avaliação de pacientes críticos em UTI. O índice kappa ponderado e a disposição gráfica de Bland-Altman foram utilizados para verificar a concordância entre os instrumentos. O coeficiente alfa de Cronbach foi utilizado para verificar a confiabilidade entre as respostas dos avaliadores dentro de cada domínio dos instrumentos. A correlação entre os instrumentos foi verificada pelo teste de correlação de Spearman.
A amostra foi composta por 103 pacientes, sendo a maioria homens (n = 56; 54%), com média de idade = 52 ± 18 anos. O principal motivo de internação nas UTIs foi insuficiência respiratória (em 44%). Os dois instrumentos apresentaram excelente concordância interobservador (> 0,90) e confiabilidade ( > 0,90) em todos os domínios. Constatou-se um baixo viés interobservador na EMU e no Perme Escore (-0,048 ± 0,350 e -0,06 ± 0,73, respectivamente). Os IC95% para os mesmos instrumentos variaram, respectivamente, de -0,73 a 0,64 e de -1,50 a 1,36, respectivamente. Além disso, verificou-se alta correlação positiva entre os dois instrumentos (r = 0,941; p < 0,001).
As versões dos dois instrumentos apresentaram alta concordância e confiabilidade interobservador.
Abstract Purpose The purpose of this study was to determine the interrater reliability of the Perme Intensive Care Unit Mobility Score. Materials and methods This was a prospective observational ...study. Data were collected from 20 patients admitted in a cardiovascular intensive care unit. The interrater reliability was tested using the intraclass correlation coefficient with 95% confidence interval and the Cohen κ coefficient of 0.9, using a 2-tailed α of .05 to provide a 90% power. Results The 15 items of the Perme ICU Mobility Score were individually analyzed. Interrater reliability (Cohen κ coefficient) for items 2, 3, 5, 6, 7, 8, 13, and 15 was 1.0000; for item 1, 0.8276; item 4, 0.8000; item 9, 0.6000; item 10, 0.7297; item 11, 0.7260; item 12, 0.7872; and item 14, 0.9048; the intraclass correlation coefficient (95% confidence interval) was 0.9880 (0.97743-0.99859). Conclusions The Perme ICU Mobility Score is a reliable tool to assess mobility status of patients admitted to the cardiovascular intensive care unit in a specific moment in time, which can be an important tool for research and clinical practice.
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