UBC Theses and Dissertations
A four-week observational study to identify cardiopulmonary trends in critically-ill sepsis patients participating in physiotherapy rehabilitation in the VGH-ICU Johnston, Kayla E.
Early mobilization (EM) has been an increasingly recognized tool in the intensive care unit (ICU) for critically ill patients. Advances in critical care medicine has led to the growth of the cohort of patients termed ‘chronically critically ill’. These patients successfully stabilize from acute critical illness, however due to deterioration of physical and/or cognitive function become dependent on full time hospital care. ICU acquired weakness (ICUAW) is a spectrum disease characterized by symmetrical physical and/or cognitive impairments developed while admitted to an ICU. The development of ICUAW is a contributing factor that leads to chronic critical illness. EM has been proposed as a tool that can be used to prevent or slow down the onset of ICUAW. PURPOSE: The purpose of this thesis was to describe and quantify the rehabilitation practices and the cardiopulmonary trends in critically ill sepsis patients in the Vancouver General Hospital’s ICU. METHODS: Patients (n = 21) who met the inclusion and exclusion criteria were observed during a four-week period, Monday to Friday. The chart notes were used for Saturdays and Sundays. Daily cardiopulmonary vitals (e.g. heart rate (HR), blood pressure (BP), respiratory rate, peripheral oxygen saturation etc.) were taken at three time points and the chart notes were used to record test results. Additionally, physiotherapy sessions were observed and described. RESULTS: Norepinephrine had a decreased median dose during EM compared to prophylactic management in the released to ward outcome group. Sequential Organ Failure Assessment (SOFA) score was significantly different between patients who achieved a mobility score of 0 compared to ≥ 3 (p = 0.014). Sitting on the edge of the bed (EOB) elicited a HR and BP response suggestive of exercise in some patients. Lastly, the cardiopulmonary trends were consistent with what was expected. CONCLUSION: Norepinephrine dose and SOFA score may independently be able to help predict the mobility score a patient is likely to achieve during physiotherapy. The HR and MAP response observed during EOB in some patients participating in EM, presented a trend suggestive of exercise and warrants further investigation.
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