Research paperFeasibility, safety, and functional recovery after active rehabilitation in critically ill surgical patients
Introduction
The survival rate of patients treated in the intensive care unit (ICU) has improved with advancements in ICU treatments. However, ICU survivors often develop physical, cognitive, and mental health disabilities after discharge, which is described as post–intensive care syndrome.[1], [2], [3], [4] Although early physical rehabilitation therapy can prevent or improve post–intensive care syndrome,[5], [6], [7], [8] it can be difficult to implement in the ICU environment because of a lack of specialised teams, equipment, and information, as well as concerns regarding safety.[9], [10], [11], [12], [13]
The majority of previous studies of ICU rehabilitation have been conducted on critically ill medical patients,[7], [14], [15], [16], [17], [18], [19], [20] with few studies conducted on critically ill surgical patients.[21], [22], [23], [24] Several studies have also been performed in mixed ICUs,[25], [26], [27], [28] but the characteristics may be different from those of surgical intensive care units (SICUs). In comparison with medical patients, those in SICUs have different reasons for admission and problems associated with their surgery, such as surgical wounds, postoperative pain, and medical comorbidities. Because of these, the rehabilitation environment, progression, feasibility, and safety in the SICU may differ from those in the medical ICU (MICU). Furthermore, most of the previous studies reporting the safety and feasibility of ICU rehabilitation were performed in well-organised ICU rehabilitation environments. However, ICU resources, such as healthcare personnel and equipment, are limited in many non-Western ICUs. Therefore, the results of previous studies may not reflect the real-world situation and the feasibility and characteristics of ICU rehabilitation require further investigation.[11], [29]
As the elderly population is growing, the proportion of older patients in the ICU is also increasing. These patients may be more vulnerable in a critical care environment and have less potential for recovery.15 Therefore, the feasibility and safety of early rehabilitation may differ from that seen in younger patients. However, few studies have focused on this issue and no studies have been conducted to evaluate the characteristics of rehabilitation according to age in SICU patients.
In the present study, the rehabilitation characteristics, functional recovery, and potential safety events in patients treated in an SICU of a teaching hospital in Korea were investigated. In addition, these parameters were assessed in patients aged <65 or ≥65 years
Section snippets
Clinical characteristics
Data from patients admitted to the SICU of the Asan Medical Center were retrospectively reviewed. The SICU is a 14-bed unit, and 500 patients are admitted annually, mainly from general surgery. The SICU also receives patients from orthopaedic surgery, plastic surgery, and urology and gynaecology departments. Patients who underwent liver transplantation were not included because they were treated in a separate ICU. Patients were required to have been treated in the SICU for at least three days
Patient characteristics
During the study period, 157 patients (59.9% male, 40.1% female) were eligible for inclusion in the study; 121 patients (77.1%) received mechanical ventilation; and the average mechanical ventilation time was 12.3 days (11.9 days in those aged < 65 and 12.6 days in those aged ≥65 years). The most common causes of SICU admission were routine postoperative care (59.2%), respiratory failure (18.5%), and septic shock (9.6%). The type of surgery categories were as follows: gastrointestinal, 38;
Discussion
The present study is the first to demonstrate that early active rehabilitation is feasible and safe in an SICU environment in Korea. Although the reason for SICU admission and associated problems differ from those of the MICU, SICU patients were also able to tolerate rehabilitation and showed functional improvement, regardless of age. A previous randomised controlled study of early, goal-directed mobilisation in the SICU showed improved mobilisation throughout the period of SICU treatment,
Conclusion
Active rehabilitation in critically ill surgical patients is feasible and safe regardless of age, although the patient's safety should be checked before treatment. Standing ability and mobility improved during rehabilitation in both age groups (<65 or ≥ 65 years). However, care should be taken when the reason for SICU admission is not routine postoperative care.
Funding
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning(NRF-2017R1A2B2005321).
CRediT authorship contribution statement
Yu Jin Seo: Data curation, Formal analysis, Writing - original draft. Sae Rom Park: Data curation, Writing - review & editing. Jung Hoon Lee: Data curation, Writing - review & editing. Chul Jung: Data curation, Writing - review & editing. Kyoung Hyo Choi: Conceptualization, Funding acquisition, Writing - review & editing. Suk-Kyung Hong: Conceptualization, Writing - review & editing. Won Kim: Conceptualization, Writing - original draft, Writing - review & editing.
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