We collected detailed information at initial hospitalization and ICU discharge. We also collected data regarding independent gait ability upon hospital discharge. All data were obtained as a usual clinical practice.
Information at admission included age, sex, body weight, body mass index (BMI), main cause of ICU admission, Charlson’s Comorbidity Index (CCI) [20 (
link)], Acute Physiology and Chronic Health Evaluation (APACHE) II score [21 (
link)], and the Sequential Organ Failure Assessment (SOFA) score [22 (
link)]. Data during ICU stay included the time to first rehabilitation assessment, duration of mechanical ventilation, time to first out-of-bed mobilization, and highest score achieved on the ICU-mobility scale (IMS) [23 (
link)]. We also investigated the incidence of adverse events during rehabilitation, such as cardiopulmonary arrest, fall to knees or the ground, inadvertent removal of medical devices, desaturation (< 90%) or more than 10% decrease from the baseline, bradypnea (< 5 breaths/min), tachypnea (> 40 breaths/min), bradycardia (< 40 beats/min), tachycardia (> 130 beats/min), hypotension (systolic blood pressure [SBP] < 80 mmHg), hypertension (SBP > 200 mmHg), and newly occurring arrhythmia. At ICU discharge, we collected incidence of ICU-acquired weakness (ICU-AW) and delirium, respectively. As mentioned above, early mobilization was performed according to the previous protocol [19 (
link)] consisted with five session levels (see Appendix
1). We investigated the number of times levels 3, 4, and 5 were achieved, and total number of times levels higher than level 2 were achieved. We calculated ICU length of stay at ICU discharge, and hospital length of stay and ratio of home discharge at hospital discharge.
The IMS provides a quick and simple bedside method of measuring the mobility of a critically ill patient. As functional endpoints in studies of rehabilitation in the ICU, the IMS provides a sensitive 11-point ordinal scale, ranging from nothing (lying/passive exercises in bed, score of 0) to independent ambulation (score of 10). ICU-AW was evaluated using Medical Research Council (MRC) sum-score by the responsible physical therapist, and a value of less than 48 was defined as having developed an ICU-AW [24 (
link), 25 (
link)]. The cooperation-level assessment was carried out, and muscle strength tests were only performed when the subject correctly answered the five questions [26 (
link)]. For the assessment of delirium, either the delirium screening tool of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [27 (
link)] or the Intensive Care Delirium Screening Checklist (ICDSC) [28 (
link)] was used according to the usual practice of each participating hospital. Outcomes other than home discharge included transfers to rehabilitation hospitals and to nursing homes.
Patients who could walk 45 m or more with or without braces were determined as gait independent. We also used mobility scale of the Barthel Index (BI) to quantitatively assess gait independence [18 (
link), 29 (
link)]. BI is the most widely used ADL scale, and its reliability and relevance have been recognized [30 (
link)]. Because we previously determined BI was an effective mobility parameter to assess the achievement of gait independence [31 ], we used this parameter in the current study. BI was measured at ICU and hospital discharge.
Watanabe S., Kotani T., Taito S., Ota K., Ishii K., Ono M., Katsukawa H., Kozu R., Morita Y., Arakawa R, & Suzuki S. (2019). Determinants of gait independence after mechanical ventilation in the intensive care unit: a Japanese multicenter retrospective exploratory cohort study. Journal of Intensive Care, 7, 53.