OBJECTIVES: Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation. DESIGN: A secondary analysis of a prospective cohort study was conducted. SETTINGS: The study was conducted in 11 ICUs in 3 teaching hospitals. PATIENTS: A total of 503 patients with ALI were included in the study. INTERVENTIONS: No interventions were used in this study. MEASUREMENTS AND MAIN RESULTS: Thirty-four percent of patients ever received PT. In multivariable analysis, factors associated with later PT were a higher Sequential Organ Failure Assessment score (hazard ratio, 0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation (with daily sedation interruption: 0.49, 0.30-0.81; without daily sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital study site (2.84, 1.89-4.26). CONCLUSIONS: In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.
OBJECTIVES: Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation. DESIGN: A secondary analysis of a prospective cohort study was conducted. SETTINGS: The study was conducted in 11 ICUs in 3 teaching hospitals. PATIENTS: A total of 503 patients with ALI were included in the study. INTERVENTIONS: No interventions were used in this study. MEASUREMENTS AND MAIN RESULTS: Thirty-four percent of patients ever received PT. In multivariable analysis, factors associated with later PT were a higher Sequential Organ Failure Assessment score (hazard ratio, 0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation (with daily sedation interruption: 0.49, 0.30-0.81; without daily sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital study site (2.84, 1.89-4.26). CONCLUSIONS: In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.
Authors: Ravi Varadhan; Carlos O Weiss; Jodi B Segal; Albert W Wu; Daniel Scharfstein; Cynthia Boyd Journal: Med Care Date: 2010-06 Impact factor: 2.983
Authors: Dale M Needham; Radha Korupolu; Jennifer M Zanni; Pranoti Pradhan; Elizabeth Colantuoni; Jeffrey B Palmer; Roy G Brower; Eddy Fan Journal: Arch Phys Med Rehabil Date: 2010-04 Impact factor: 3.966
Authors: Mark C Pohlman; William D Schweickert; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn McCallister; Jesse B Hall; John P Kress Journal: Crit Care Med Date: 2010-11 Impact factor: 7.598
Authors: Tarek Sharshar; Sylvie Bastuji-Garin; Robert D Stevens; Marie-Christine Durand; Isabelle Malissin; Pablo Rodriguez; Charles Cerf; Hervé Outin; Bernard De Jonghe Journal: Crit Care Med Date: 2009-12 Impact factor: 7.598
Authors: Jennifer M Zanni; Radha Korupolu; Eddy Fan; Pranoti Pradhan; Kashif Janjua; Jeffrey B Palmer; Roy G Brower; Dale M Needham Journal: J Crit Care Date: 2009-11-26 Impact factor: 3.425
Authors: Chris Burtin; Beatrix Clerckx; Christophe Robbeets; Patrick Ferdinande; Daniel Langer; Thierry Troosters; Greet Hermans; Marc Decramer; Rik Gosselink Journal: Crit Care Med Date: 2009-09 Impact factor: 7.598
Authors: S Jean Hsieh; Graciela J Soto; Aluko A Hope; Ana Ponea; Michelle N Gong Journal: Am J Respir Crit Care Med Date: 2015-01-01 Impact factor: 21.405
Authors: Selina M Parry; Laura D Knight; Bronwen Connolly; Claire Baldwin; Zudin Puthucheary; Peter Morris; Jessica Mortimore; Nicholas Hart; Linda Denehy; Catherine L Granger Journal: Intensive Care Med Date: 2017-02-16 Impact factor: 17.440
Authors: Victor D Dinglas; Ann M Parker; Dereddi Raja S Reddy; Elizabeth Colantuoni; Jennifer M Zanni; Alison E Turnbull; Archana Nelliot; Nancy Ciesla; Dale M Needham Journal: Ann Am Thorac Soc Date: 2014-10
Authors: Sarah Elizabeth Jolley; Marc Moss; Dale M Needham; Ellen Caldwell; Peter E Morris; Russell R Miller; Nancy Ringwood; Megan Anders; Karen K Koo; Stephanie E Gundel; Selina M Parry; Catherine L Hough Journal: Crit Care Med Date: 2017-02 Impact factor: 7.598