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Research ArticleOriginal Research

Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness

Dena H Tran, Parth Maheshwari, Zain Nagaria, Harsh Y Patel and Avelino C Verceles
Respiratory Care August 2020, 65 (8) 1168-1173; DOI: https://doi.org/10.4187/respcare.07437
Dena H Tran
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland.
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  • For correspondence: [email protected]
Parth Maheshwari
Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Zain Nagaria
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Harsh Y Patel
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland.
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Avelino C Verceles
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland.
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Abstract

BACKGROUND: Survivors of prolonged ICU admissions are bedridden and immobilized for an extended period of time. These patients often are discharged to long-term acute care hospitals (LTACHs) for continued medical care and rehabilitation. Early ambulation has been associated with improved functional outcomes and lower readmission rates in hospitalized patients. The aim of this study was to determine the association between ambulatory status and discharge disposition in survivors of prolonged ICU stays who were admitted to an LTACH.

METHODS: We performed a retrospective cohort study of 285 survivors of prolonged ICU stays who were admitted to a university-affiliated LTACH facility from 2010 to 2013. Outcomes of interest included comparing the relationship between ambulatory status and disposition status (ie, home vs acute rehabilitation facility, nursing home, readmission to an ICU, or death).

RESULTS: The mean age of our cohort was 59.0 ± 15.3 y, with 129 (45%) males, 148 (52%) African-American, 123 (43%) white, and 14 (5%) of subjects other races. Most of these subjects were transferred from a medical ICU (68%). The median ICU and LTACH lengths of stay were 25.5 (13–38.8) d and 34.0 (14–64) d, respectively. Thirty-eight (13.3%) subjects were discharged home, 25 (8.7%) to an acute rehabilitation facility, 70 (24.6%) to a nursing home, 139 (48.8%) were readmitted to an ICU, and 13 (4.6%) died. Of 285 total subjects, 74 (26%) ambulated during physical therapy, while 211 (74%) subjects never ambulated. Of those who ambulated, 24 (32.4%) went home, whereas 14 of 211 (6.6%) subjects who did not ambulate went home (P < .001).

CONCLUSIONS: The ability to ambulate was associated with a greater likelihood of being discharged home in survivors of prolonged ICU stays who were admitted to an LTACH. These results suggest that mobility training for survivors of prolonged ICU stays in LTACH facilities should be strongly emphasized to improve their likelihood of being discharged home.

  • early ambulation
  • physical therapy modalities
  • long-term care
  • critical illness
  • patient discharge

Footnotes

  • Correspondence: Avelino C Verceles MD MSc, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland School of Medicine, 110 S Paca St, Baltimore, MD 21201. E-mail: avercele{at}medicine.umaryland.edu
  • This research was performed at the University of Maryland Medical Center Midtown Campus in Baltimore, Maryland.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (8)
Respiratory Care
Vol. 65, Issue 8
1 Aug 2020
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Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness
Dena H Tran, Parth Maheshwari, Zain Nagaria, Harsh Y Patel, Avelino C Verceles
Respiratory Care Aug 2020, 65 (8) 1168-1173; DOI: 10.4187/respcare.07437

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Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness
Dena H Tran, Parth Maheshwari, Zain Nagaria, Harsh Y Patel, Avelino C Verceles
Respiratory Care Aug 2020, 65 (8) 1168-1173; DOI: 10.4187/respcare.07437
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Keywords

  • early ambulation
  • physical therapy modalities
  • long-term care
  • critical illness
  • patient discharge

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