title: Factors associated with timing of initiation of physical therapy in patients with acute lung injury.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A secondary analysis of a prospective cohort study was conducted.
  
  
  METHODS
  The study was conducted in 11 ICUs in 3 teaching hospitals.
  
  
  METHODS
  A total of 503 patients with ALI were included in the study.
  
  
  METHODS
  No interventions were used in this study.
  
  
  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.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD. Electronic address: pmendez@jhmi.edu.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
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: Jonathan E
authors.initials: JE
authors.lastname: Sevransky
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000534:rehabilitation*; D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008396:Maryland; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute lung injury; Critical illness; Intensive care unit; Mechanical ventilation; Physical therapy; Rehabilitation