[Status and influencing factors analysis of activity level in patients with mechanical ventilation in intensive care unit].

OBJECTIVE

To analyze the status and influencing factors of activity level among mechanically ventilated patients in intensive care unit (ICU), and to provide a references for promoting the implementation of early rehabilitation and rapid recovery in critically ill patients.

METHODS

A prospective observational study was conducted, enrolling mechanically ventilated patients admitted to the ICU of Shanghai General Hospital from January 2023 to December 2024 as research subjects. Data including age, gender, duration of mechanical ventilation, length of ICU stay, modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Charlson Comorbidity Index (CCI), incidence of hypoproteinemia, as well as the administration of vasoactive agents, analgesics, sedatives, nerve block drugs and glucocorticoids were collected. The Perme Activity Measure for ICU Patients (PERME) scale was used to assess patients' activity level. A generalized linear model was applied to analyze the influencing factors of patients' PERME scores.

RESULTS

A total of 175 mechanically ventilated patients in the ICU were enrolled, including 129 males and 46 females, with a mean age of (65.20±16.15) years (range: 19-93 years). The median length of ICU stay was 10.0 (5.0, 19.0) days, and the median duration of mechanical ventilation was 7.0 (3.0, 11.0) days. The reasons for ICU admission included respiratory diseases, digestive system diseases, cardiovascular system diseases, sepsis and other conditions. The median PERME score of ICU mechanically ventilated patients at discharge was 7.0 (2.0, 16.0). The scores of the four dimensions, namely ability to follow commands for movement, movement disorders, bed mobility and ambulation, were 5.0 (0.0, 7.0), 1.0 (1.0, 2.0), 0.0 (0.0, 6.0) and 0.0 (0.0, 2.0), respectively. Univariate analysis indicated that age, administration of vasoactive agents, analgesics and sedatives, mNUTRIC score, hypoproteinemia, CCI score, duration of mechanical ventilation and length of ICU stay had significant effects on the PERME scores of ICU mechanically ventilated patients (all P<0.05). Taking the PERME score as the dependent variable, and the 9 statistically significant variables identified in univariate analysis (age, mNUTRIC score, hypoproteinemia, CCI score, administration of vasoactive agents, analgesics, sedatives, duration of mechanical ventilation and length of ICU stay) as independent variables, a generalized linear model analysis was performed. The results showed that hypoproteinemia [geometric mean ratio (GMR)=1.459, P=0.028], administration of vasoactive agents (GMR=1.411, P=0.014), administration of sedatives (GMR=2.411, P=0.044) and duration of mechanical ventilation (1-3 days vs. >7 days: GMR=2.014, P=0.006) were the main influencing factors for the activity level of ICU mechanically ventilated patients.

CONCLUSIONS

The activity levels of patients with mechanical ventilation in ICUs are relatively low. Clinical attention should be focused on patients with hypoproteinemia, using vasoactive and sedative drugs, prolonged mechanical ventilation, thereby enhancing the activity levels of these patients.