Factors associated with receipt of physical therapy consultation in patients requiring prolonged mechanical ventilation.
BACKGROUND
Mobilization of critically ill patients in the intensive care unit is associated with improved function at hospital discharge and reduced duration of mechanical ventilation (MV). Few studies, however, focus on physical therapy (PT) in patients on prolonged mechanical ventilation (PMV) despite their high risk of immobility and poor outcomes.


OBJECTIVE
The objective of this study was to identify factors associated with the receipt of PT consultation among patients requiring PMV. We hypothesized that key factors including age, severity of illness, and presence of a tracheostomy are associated with PT consultation.


METHODS
This was a retrospective cohort study of adults on MV for 14 days or longer for acute respiratory failure at an academic medical center. Primary outcome was PT consultation by day 14 of MV. We examined associations between the following key predictors chosen a priori and PT consultation: age, tracheostomy, illness severity, oxygenation status, shock, hemodialysis, and medical service using multivariable logistic regression. Wilcoxon rank sum testing was used to test relationship between sedation and PT.


RESULTS
We identified 175 patients requiring PMV at our institution. Most were middle-aged (mean, 49.7 [SD, 18.5] years old) men (65%) with high illness severity (mean Acute Physiology and Chronic Health Evaluation III score, 86 [SD, 40]). Less than half of all patients requiring PMV (78/175, 45%) received PT consultation in the intensive care unit, and most failed to progress with therapy beyond range-of-motion exercises (85%). Failure to progress was associated with level of sedation (med Ramsay score 4.5 [interquartile range, 3-6] vs 3.5 [interquartile range, 3-5]; P = .01). Presence of a tracheostomy and prehospital nonambulatory status were associated with receipt of PT by day 14 of MV (odds ratio, 6.94 and 3.42, respectively; P ≤ .05).


CONCLUSIONS
In our study, we found that PT for PMV patients occurs infrequently and is generally of low intensity. Level of sedation, presence of a tracheostomy, and prehospital nonambulatory status were associated with receipt of PT consultation by day 14 of MV.
Sarah E. Jolley, MD, is a senior fellow in the University of Washington Division of Pulmonary and Critical Care Medicine. Her research interests include early mobilization of critically ill patients and long-term outcomes in survivors of Acute Respiratory Distress Syndrome. Ellen Caldwell, MSc, is a biostatistician with the division of Pulmonary and Critical Care Medicine at the University of Washington. Her research interests include critical and emergency care. Catherine L. Hough, MD, MSc, is an associate professor with the Division of Pulmonary and Critical Care Medicine at the University of Washington. Her research interests include neuromuscular outcomes in survivors of critical illness and long-term physical and functional outcomes in survivors of Acute Respiratory Distress Syndrome.
Sarah E
SE
Jolley
Ellen
E
Caldwell
Catherine L
CL
Hough
D015331:Cohort Studies; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D014139:Tracheostomy; D014861:Washington