title: Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority.
abstract: OBJECTIVE
  Ambulation of patients with acute respiratory failure may be unnecessarily limited in the acute intensive care setting. We hypothesized that ambulation of patients with acute respiratory failure would increase with transfer to an intensive care unit where activity is a key component of patient care.
  
  
  METHODS
  Pre-post cohort study of respiratory failure patients.
  
  
  METHODS
  Adult intensive care units at LDS Hospital.
  
  
  METHODS
  Respiratory failure patients requiring >4 days of mechanical ventilation who were transferred from other LDS Hospital intensive care units to the respiratory intensive care unit.
  
  
  METHODS
  We prospectively applied an early activity protocol to all consecutive respiratory failure patients transferred to the respiratory intensive care unit.
  
  
  RESULTS
  We studied 104 respiratory failure patients who required mechanical ventilation for >4 days. Transferring a patient to the respiratory intensive care unit substantially increased the probability of ambulation (p < .0001). After 2 days in the respiratory intensive care unit, the number of patients ambulating had increased three-fold compared with pretransfer rates. Female gender (p = .019), the absence of sedatives (p = .009), and lower Acute Physiology and Chronic Health Evaluation II scores (p = .017) also predicted an increased probability of ambulation. Improvements in ambulation with transfer to the respiratory intensive care unit remained significant after adjustment for Acute Physiology and Chronic Health Evaluation II scores and other covariates.
  
  
  CONCLUSIONS
  Transfer of acute respiratory failure patients to the respiratory intensive care unit substantially improved ambulation, independent of the underlying pathophysiology. The intensive care environment may contribute unnecessary immobilization throughout the course of acute respiratory failure. Sedatives, even given intermittently, substantially reduce the likelihood of ambulation. Controlled studies are needed to determine whether intensive care unit immobilization contributes to long-term neuromuscular dysfunction or whether early intensive care unit activity improves outcomes.
authors: Department of Medicine, LDS Hospital, Salt Lake City, UT, USA.
authors: George E
authors: GE
authors: Thomsen
authors: Gregory L
authors: GL
authors: Snow
authors: Larissa
authors: L
authors: Rodriguez
authors: Ramona O
authors: RO
authors: Hopkins
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010360:Patient Transfer; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000628:therapy*; D016896:Treatment Outcome; D016138:Walking