title: Occupational therapy for patients with acute lung injury: factors associated with time to first intervention in the intensive care unit.
abstract: OBJECTIVE
  Very early occupational therapy intervention in the intensive care unit (ICU) improves patients' physical recovery. We evaluated the association of patient, ICU, and hospital factors with time to first occupational therapy intervention in ICU patients with acute lung injury (ALI).
  
  
  METHODS
  We conducted a prospective cohort study of 514 consecutive patients with ALI from 11 ICUs in three hospitals in Baltimore, MD.
  
  
  RESULTS
  Only 30% of patients ever received occupational therapy during their ICU stay. Worse organ failure, continuous hemodialysis, and uninterrupted continuous infusion of sedation were independently associated with delayed occupational therapy initiation, and hospital study site and admission to a trauma ICU were independently associated with earlier occupational therapy.
  
  
  CONCLUSIONS
  Severity of illness and ICU practices for sedation administration were associated with delayed occupational therapy. Both hospital study site and type of ICU were independently associated with timing of occupational therapy, indicating modifiable environmental factors for promoting early occupational therapy in the ICU.
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Nancy
authors.initials: N
authors.lastname: Ciesla
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000046:Academic Medical Centers; D055371:Acute Lung Injury / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy; D000328:Adult; D000368:Aged; D015142:Baltimore; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors