Christiana Care Health System, Newark, DE
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Critical Care - ICU Management
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: Over the past decade there has been increased attention to the early mobilization of hospitalized patients, including patients with acute respiratory distress or illness. However, there is little evidence to suggest the benefit or feasibility of physical therapy managed mobility with patients who require noninvasive ventilation (NIV). There are a few reported studies which have shown the effectiveness of NIV in exercise training during pulmonary rehabilitation, and the use of bi-level positive airway pressure (BiPAP) on patients who have chronic obstructive pulmonary disease (COPD). At Christiana Care Health System the standard of care since 2012 has been for the physical therapy therapists to mobilize patients with high oxygen requirements using NIV. The purpose of this study is to examine the benefits of early mobilization using noninvasive ventilation.
METHODS: To qualify for the NIV progam patients had to be: > 18years, ambulatory at baseline, and with documentation of desaturation (<88%) during routine physical therapy requiring 100% oxygen. Patients admitted to the Christiana Hospital on the pulmonary stepdown and medical intensive care unit (MICU) from 2012 to 2014, who were clinically eligible for NIV treatment and participated in routine physical therapy with close respiratory monitoring were included in the analysis. The control group consisted of successive patients with similar entry criteria and admitted between 2011 and 2012. Wilcoxon-rank sum test was used to compare change in ambulation distance from first to last trial and maximum ambulation distance between patients in the NIV program and controls. Linear regression was used to adjust for potential confounders. Because of the skewed distributions, all variables were transformed using a Box-Cox transformation
RESULTS: The final dataset included 17 patients in the NIVprogram and 64 historic controls. The median ages for the NIV and control groups were 70.0 and 72.5 years, respectively. A total of 71% of the NIV patients and 91% of the controls were white and 29% of the NIV and 69% of the controls were female. The median change in ambulation distance from first trial to last trial was 125 ft in the intervention group as compared to 0 ft in the control (p<0.001) and remained significant after adjusting for first ambulation distance, age, gender and race. The median maximum ambulation throughout all sessions in the intervention group was 300 ft as compared to 65 ft in the control group (p<0.001) and remained significant after adjusting for confounders. Ten out of 17 (59%) patients in the intervention group were discharged home compared to 50% of the control group (p=0.5). No adverse events occurred.
CONCLUSIONS: There was a significant change in ambulation distance from first to last sessions in patients who used NIV. Additionally the maximum ambulation distance was significantly higher in patients who used NIV
CLINICAL IMPLICATIONS: The use of NIV in routine physical therapy with patients who have high oxygen requirements appears to be safe and effective. Further research is needed to confirm the efficacy of NIV in routine early mobilization. As well as the effect on length of stay, long term functional outcome, and discharge disposition.
DISCLOSURE: The following authors have nothing to disclose: James Halbert, Patty McGraw, Carol Gray, Gerald O'Brien, Vinay Maheshwari, Rick Caplan, Claudine Jurkovitz
No Product/Research Disclosure Information
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited:
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.