Frailty in Critical Care: Patient Mobility as a Clinical Predictor
CCCF ePoster library. Walsh S. Oct 3, 2017; 198174; 66
Dr. Steve Walsh
Dr. Steve Walsh
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Frailty in Critical Care: Patient Mobility as a Clinical Predictor

Walsh, Stephen; Searle, Sam; Davis, Giselle; Mercier, Tara; Haroon, Babar; McMullen, Sarah; Rockwood, Kenneth.

General Internal Medicine, Dalhousie University, Halifax, Nova Scotia; Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia; ICU Physiotherapy, QEII Health Sciences Center, Halifax, Nova Scotia; ICU Physiotherapy, QEII Health Sciences Center, Halifax, Nova Scotia; Critical Care, Dalhousie University, Halifax, Nova Scotia; Critical Care, Dalhousie University, Halifax, Nova Scotia; Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia.

 


Introduction: Frailty is an increasingly recognized phenomenon in the healthcare of older-adults. Patient mobility is an important and well-recognized marker of clinical frailty1. Early mobilization in the intensive care unit (ICU) improves patient outcomes2,3. Changes in mobility of individuals who are acutely unwell is under studied and has important implications on recovery and prognosis. 

Objectives: To investigate patient mobility as a clinical predictor in a critically ill older-adult patient population. Specifically, to investigate whether severity of illness at time of ICU admission is predictive of mobility performance and to assess whether changes in patient mobility correlate with in-hospital mortality. 

Methods: A single center prospective cohort study involving critically ill patients aged 65 and older admitted to the QEII’s medical-surgical ICU. APACHE II scores were calculated at time of ICU admission to stratify critical illness severity. Physiotherapists integrated the HABAM into routine daily mobility assessments in the ICU. Additional items relevant to mobility in the ICU were added to the HABAM based on interdisciplinary team consensus - creating a modified CritCare-HABAM. Patient descriptive and changes in patient mobility up to four days in ICU were analyzed against in-hospital mortality using univariate regression analysis. Changes in patient mobility were also analyzed according to admission APACHE II score.  This represents the first participants enrolled and completed hospitalization. Enrolment is ongoing.

Results: A total of 38 patients were recruited and 34 were mobilized at least two days in ICU. Average APACHE II score was 23.3 (SD 6.57). Ten participants (26%) died in hospital. The CritCare-HABAM predicted in hospital mortality if there was a failure to improve in any of the three mobility domains or two-out-of-three domains (p=0.023 and p=0.039, respectively) whereas if there was failure to improve in any of the three mobility domains of the HABAM, there was a trend for significance (p=0.059). Neither increased severity of critical illness (APACHE II > 23) nor frailty (Clinical Frailty Scale > 4) were associated with decreased mobility performance (p=0.19).

Conclusion: The HABAM can be used in the ICU and changes in mobility predict in hospital death.
 
 

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