Mobilisation is feasible in intensive care patients receiving vasoactive therapy: an observational study.

Anneke Rebel, Vince Marzano, Margot GREEN, Karlee Johnston, Jiali Wang, Teresa Neeman, Imogen Mitchell, Bernie BISSETT

Research output: Contribution to journalArticle

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Abstract

Background
Mobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. Objectives
To describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.
Methods: Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October–December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates. Results: In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23–13.59 and odds ratio = 2.50, 95% confidence interval = 0.95–6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1–2) in 31%, moderate (IMS = 3–5) in 51%, and high (IMS = 6–10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001). Conclusion: In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.
Original languageEnglish
Pages (from-to)139-146
Number of pages8
JournalAustralian Critical Care
Volume32
Issue number2
DOIs
Publication statusPublished - 1 Mar 2019

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Critical Care
Observational Studies
Intensive Care Units
Therapeutics
Hypotension
Odds Ratio
Confidence Intervals
APACHE
Tertiary Healthcare
Linear Models
Arterial Pressure
Cohort Studies
Retrospective Studies
Hemodynamics
Databases
Safety

Cite this

Rebel, Anneke ; Marzano, Vince ; GREEN, Margot ; Johnston, Karlee ; Wang, Jiali ; Neeman, Teresa ; Mitchell, Imogen ; BISSETT, Bernie. / Mobilisation is feasible in intensive care patients receiving vasoactive therapy: an observational study. In: Australian Critical Care. 2019 ; Vol. 32, No. 2. pp. 139-146.
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title = "Mobilisation is feasible in intensive care patients receiving vasoactive therapy: an observational study.",
abstract = "BackgroundMobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. ObjectivesTo describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.Methods: Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October–December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates. Results: In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5{\%} of vasoactive days). Low (76.8{\%}) and moderate (13.7{\%}) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4{\%}) dose therapy (odds ratio = 5.50, 95{\%} confidence interval = 2.23–13.59 and odds ratio = 2.50, 95{\%} confidence interval = 0.95–6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1–2) in 31{\%}, moderate (IMS = 3–5) in 51{\%}, and high (IMS = 6–10) in 18{\%} of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3{\%}), associated with lower mean arterial pressure (p = 0.001). Conclusion: In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.",
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Mobilisation is feasible in intensive care patients receiving vasoactive therapy: an observational study. / Rebel, Anneke; Marzano, Vince; GREEN, Margot; Johnston, Karlee; Wang, Jiali; Neeman, Teresa; Mitchell, Imogen; BISSETT, Bernie.

In: Australian Critical Care, Vol. 32, No. 2, 01.03.2019, p. 139-146.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mobilisation is feasible in intensive care patients receiving vasoactive therapy: an observational study.

AU - Rebel, Anneke

AU - Marzano, Vince

AU - GREEN, Margot

AU - Johnston, Karlee

AU - Wang, Jiali

AU - Neeman, Teresa

AU - Mitchell, Imogen

AU - BISSETT, Bernie

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BackgroundMobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. ObjectivesTo describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.Methods: Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October–December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates. Results: In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23–13.59 and odds ratio = 2.50, 95% confidence interval = 0.95–6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1–2) in 31%, moderate (IMS = 3–5) in 51%, and high (IMS = 6–10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001). Conclusion: In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.

AB - BackgroundMobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy. ObjectivesTo describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.Methods: Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October–December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates. Results: In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23–13.59 and odds ratio = 2.50, 95% confidence interval = 0.95–6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1–2) in 31%, moderate (IMS = 3–5) in 51%, and high (IMS = 6–10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001). Conclusion: In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.

KW - Critical care

KW - Intensive care

KW - Mobility

KW - Physiotherapy (techniques)

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U2 - 10.1016/j.aucc.2018.03.004

DO - 10.1016/j.aucc.2018.03.004

M3 - Article

VL - 32

SP - 139

EP - 146

JO - Australian Critical Care

JF - Australian Critical Care

SN - 1036-7314

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