title: Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure.
abstract: BACKGROUND
  Hospitals are under pressure to provide care that not only shortens hospital length of stay but also reduces subsequent hospital admissions. Hospital readmissions have received increased attention in outcome reporting. The authors identified survivors of acute respiratory failure who then required subsequent hospitalization. A cohort of acute respiratory failure survivors, who participated in an early intensive care unit (ICU) mobility program, was assessed to determine if variables from the index hospitalization predict hospital readmission or death, within 12 months of hospital discharge.
  
  
  METHODS
  Hospital database and responses to letters mailed to 280 acute respiratory failure survivors. Univariate predictor variables shown to be associated with hospital readmission or death (P < 0.1) were included in a multiple logistic regression. A stepwise selection procedure was used to identify significant variables (P < 0.05).
  
  
  RESULTS
  Of the 280 survivors, 132 (47%) had at least 1 readmission or died within the first year, 126 (45%) were not readmitted and 22 (8%) were lost to follow-up. Tracheostomy [odds ratio (OR), 4.02 (95%CI, 1.72-9.40)], female gender [OR, 1.94 (95%CI, 1.13-3.32)], a higher Charlson Comorbidity Index assessed upon index hospitalization discharge [OR, 1.15 (95%CI, 1.01-1.31)] and lack of early ICU mobility therapy [OR, 1.77 (95%CI, 1.04-3.01)] predicted readmission or death in the first year postindex hospitalization.
  
  
  CONCLUSIONS
  Tracheostomy, female gender, higher Charlson Comorbidity Index and lack of early ICU mobility were associated with readmissions or death during the first year. Although the mechanisms of increased hospital readmission are unclear, these findings may provide further support for early ICU mobility for patients with acute respiratory failure.
authors.affiliation: Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. pemorris@wfubmc.edu
authors.forename: Peter E
authors.initials: PE
authors.lastname: Morris
authors.forename: Leah
authors.initials: L
authors.lastname: Griffin
authors.forename: Michael
authors.initials: M
authors.lastname: Berry
authors.forename: Clif
authors.initials: C
authors.lastname: Thompson
authors.forename: R Duncan
authors.initials: RD
authors.lastname: Hite
authors.forename: Chris
authors.initials: C
authors.lastname: Winkelman
authors.forename: Ramona O
authors.initials: RO
authors.lastname: Hopkins
authors.forename: Amelia
authors.initials: A
authors.lastname: Ross
authors.forename: Luz
authors.initials: L
authors.lastname: Dixon
authors.forename: Susan
authors.initials: S
authors.lastname: Leach
authors.forename: Edward
authors.initials: E
authors.lastname: Haponik
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome