Quantification of the negative impact of sedation and inotropic support on achieving early mobility in burn patients in ICU: A single center observational study
Quantification of the negative impact of sedation and inotropic support on achieving early mobility in burn patients in ICU: A single center observational study
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DOI：
10.1016/j.burns.2021.09.015
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发表时间：
2021-11-29
期刊：
影响因子：
2.7
通讯作者：
Edgar, Dale W.
中科院分区：
文献类型：
--
作者：
Bright, Lauren;Van der Lee, Lisa;Edgar, Dale W.
A B S T R A C T简介：重症监护室（ICU）中烧伤幸存者的早期康复可以说比一般人群更具挑战性。早期达到功能垂直度里程碑（FVM）有可能改善ICU患者卧床休息和不动的不利影响，并降低医疗费用。然而，烧伤后达到FVM的时间受到诸如镇静方法、心血管稳定性、机械通气、急性皮肤重建和急性重症监护期间住院时间（LOS）等因素的影响。目的/目标：本研究的目的是确定接受ICU护理的烧伤成人患者早期实现FVM与影响停止卧床休息的因素之间的相关性，并探讨临床医生记录的实现FVM的障碍。方法：进行一项为期5年的回顾性观察性队列研究。对每例病例的数字病历进行了审查，以探索可能导致持续卧床休息的FVM发作和患者因素，例如使用输注的镇静剂和/或正性肌力药物、机械通气、烧伤手术、全身表面积（TBSA）、ICU住院时间和ICU前实践。使用逻辑回归来检查ICU幸存者的FVM成绩与治疗和损伤因素之间的关系。结果：可用于分析的总样本包括64例患者。当镇静/躁动评分在推荐范围内时，达到FVM的几率是超出这些范围的21倍。当输注深度镇静剂时，与没有输注这些药物的时期相比，实现FVM的几率降低了87%。在
A B S T R A C T Introduction: Early rehabilitation for burns survivors in the intensive care unit (ICU) is arguably more challenging than the general population. Early achievement of functional verticality milestones (FVMs) has the potential to ameliorate the detrimental effects of bed rest and immobility observed in ICU patients and reduce healthcare costs. However, the time to achieving FVMs after burn injury is influenced by factors such as sedation practices, cardiovascular stability, mechanical ventilation, acute skin reconstruction and length of stay (LOS) during the acute intensive care period. Objectives/Aims: The aims of this study were to identify the association between early achievement of FVMs and factors influencing cessation of bedrest in adult patients with burns receiving ICU care, and to explore barriers to achievement of FVMs as recorded by clinicians. Methods: A 5-year retrospective observational cohort study was conducted. The digital medical records were reviewed for each case to explore episodes of FVMs and patient factors which may contribute to persistent bed rest, such as use of infused sedative and/or inotropic medication, mechanical ventilation, burn surgery, total body surface area (TBSA), ICU length of stay and pre-ICU practices. Logistic regression was used to examine the association between FVM achievement and treatment and injury factors in ICU survivors. Results: The total sample available for analysis included 64 patients. When sedation/agitation score was within recommended limits, odds of achieving FVMs was 21 times greater than periods outside those limits. When deep sedatives were infused, the odds of achieving FVMs decreased by 87% compared to periods when there was no infusion of these medications. In