Optimizing Mobility for Critically Ill Patients Undergoing Continuous Renal Replacement Therapy: A Retrospective Cohort Study (MOvE CRRT)
CCCF ePoster library. Trumble D. Nov 9, 2018; 234189
Disclosure(s): Project leads Dr. Oleksa Rewa and Dr. Drayton Trumble were supported by an Alberta Health Services Medical Affairs Quality Innovation Fund Grant. No other disclosures.
Dr. Drayton Trumble
Dr. Drayton Trumble
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Abstract
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INTRODUCTION

Critically ill patients admitted to the intensive care unit (ICU) requiring continuous renal replacement therapy (CRRT) can suffer from decreased mobility interventions due to fear of adverse events. Physical therapy (PT) interventions have been shown to be feasible and safe in patients undergoing CRRT; however, there are few published recommendations or protocols [1]. This warrants a baseline audit of PT interventions in those receiving CRRT to help guide future mobilization practices in these patients.



OBJECTIVES

Our primary objective was to describe the incidence of PT interventions in patients receiving CRRT. Additionally, we sought to highlight possible barriers to treatment, identify any adverse events, and prepare recommendations for future protocols aimed at increasing PT interventions in ICU patients receiving CRRT.



METHODS

We conducted a retrospective observational cohort study of patients over the age of 18 years admitted to the General Systems ICU at the University of Alberta Hospital between April 1, 2015, and April 1, 2017. Any patient with a length of stay (LOS) greater than 7 days and CRRT treatment for greater than 72 hours was considered. We generated a matched cohort with similar age, admission criteria, and acuity of illness. Data collection was conducted via a focused audit of our clinical information system (CIS). Data were extracted on socio-demographics, diagnoses, chronic diseases, illness severity, and treatment intensity. PT data was collected from the repository’s physiotherapy charting and included treatment delays, adverse events, and the highest level of mobilization achieved. Data analysis was primarily descriptive. Data was collected from any PT sessions between initiation and discontinuation of CRRT, regardless of whether CRRT was running during the specific PT intervention.



RESULTS

Ninety-two patients fit our criteria, of which 50 were randomly selected as cases. The median age was 55 years, 27 (54%) were male, and median admission APACHE II and GCS scores were 30 and 12.5 respectively. The median total CRRT time was 141 hours. No patients died while in ICU, however, 10 (20%) died in hospital. These patients were matched with 51 similar control patients. No adverse events during physiotherapy were reported. CRRT line access during physiotherapy was a common concern of PTs or RNs, and limited or postponed treatment in 7 (14%) patients. Femoral dialysis catheters were most often listed as the site of concern. For CRRT patients, the highest level of mobility achieved was ambulation in 1 (2%), active in 17 (34%), passive in 13 (26%), and none in 19 (38%). In our 51 matched non-CRRT patients, the highest level of mobility achieved during their entire ICU admission was ambulatory in 33 (65%), active in 10 (20%), passive in 2 (4%), none in 4 (8%), and incomplete data in 2 (4%). Thirteen (26%) CRRT patients had an interruption of their PT program of at least 1 day for medical reasons, compared to 22 (43%) in the matched controls. Four (8%) of the CRRT patients had their PT program delay attributed to CRRT.



CONCLUSION

PT interventions in ICU patients undergoing CRRT continues to appear feasible and safe. CRRT patients were mobilized to a lesser degree than a matched cohort of similar illness severity. Once started, PT schedules were interrupted less often in CRRT patients than in controls. A protocol defining PT interventions in this population, ensuring to highlight line concern recommendations, is needed.


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