Vermei, L. (2016) Leidt het pakket aan maatregelen ter bevordering van de functionaliteit van langdurig opgenomen patiënten op de intensive care tot een verbetering van de functionele zelfstandigheid? thesis, Medicine.
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Abstract
Introduction: prolonged intensive care unit (ICU) stay is associated with severe physical and mental disabilities. The combined disabilities associated with a long ICU stay are currently summarised as ‘Post Intensive Care Syndrome’ (PICS). In order to assess the severity of post-ICU disabilities we introduced the systematic scoring of the Barthel Index (BI). As of now, specific therapies to treat PICS seem to be lacking. Therefore we developed a set of interventions aiming for the prevention of PICS. This included reduction of the length of mechanical ventilation, early mobilisation and non-drug treatment of delirium. The aim of this study is to investigate whether the introduction of this set of interventions is associated with an increase in functional abilities after ICU discharge. Methods: we conducted a single-centre retrospective cohort study at the ICU of Medical Centre Leeuwarden, The Netherlands. Patients admitted between 2012 and 2014 and a length of stay (LOS) of >48 hours were included. By protocol a BI was scored in all patients during this period within two days after ICU discharge. Patient characteristics were extracted from the National Intensive Care Evaluation database. We used descriptive statistics, uni- and multivariate analyses. A p value < 0,5 was considered statistically significant. Results: n=825. Median BI increased from 9 [4-14] in 2012 to 11 [7-17] in 2013, p=<0,001. Between 2013 and 2014 there was no significant difference. The observed increase in BI between 2012 and 2013 was also significant in all individual domains of the BI. After correction for baseline confounders in a multivariate analysis, the BI in the cohort year 2012 remained significantly lower in comparison to 2013 and 2014. The observed improvement in functional ability over time was not associated with a rise in ICU length of stay. Conclusion: in comparison to index year 2012, median BI increased significantly with two points in 2013/2014 without an increased ICU LOS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Dagelijks begeleider and Boerma, dr. E.C. internist-intensivist and Medisch Centrum Leeuwarden, afdeling Intensive Care |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1838 |
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