In this observational study, the relationship between physical function and level of consciousness was evaluated at hospital discharge and subsequently how this was effected long-term mortality. Before we delve into the study itself there are limitations of the study we need to be aware of. The study took place in a single ICU in South Korea and only included 246 patients so caution needs to be applied when extrapolating these findings to other ICUs in different countries as the results may not be applicable.
As ICU and critical care management improves mortality rates are decreasing but long-term outcomes remain poor and there is a need to understand why before we can implement appropriate and effective changes to shit the balance of surviving and maintaining quality of life. In essence the researchers investigated whether simplified measurement of physical function and level of
consciousness by nurses could predict long-term outcomes after discharge in ICU patients.
On discharge from the ICU the nurses were measuring a number of things;
- Levels of opiates – converted to Fentanyl equivalence
- Levels of Benzodiazepines – recorded using Medazolam
- Delirium – Using RASS and CAM
- Level of function – 3 Groups;
- Alert and walking
- Alert and bed bound
- Not alert and bed bound
These scores and categories were then used alongside 2 year mortality to see if any relationship was found. As you could predict survivors at two years were more likely to have been alert and walking when discharged from the ICU than those who were bedridden.
What does this mean clinically? Well at this stage large sweeping conclusions cannot be made as a result of this study but for physio’s working in a critical care setting it does help highlight the importance of early rehab. If anything rehab cannot start soon enough. As more studies like this take place there will be growing support for 7 day ICU services which have a balanced rehab and respiratory focus.