Factors associated with receipt of physical therapy consultation in patients requiring prolonged mechanical ventilation.

BACKGROUND/

INTRODUCTION

Mobilization of critically ill patients in the intensive care unit is associated with improved function at hospital discharge and reduced duration of mechanical ventilation (MV). Few studies, however, focus on physical therapy (PT) in patients on prolonged mechanical ventilation (PMV) despite their high risk of immobility and poor outcomes.

OBJECTIVE/AIMS: The objective of this study was to identify factors associated with the receipt of PT consultation among patients requiring PMV. We hypothesized that key factors including age, severity of illness, and presence of a tracheostomy are associated with PT consultation.

METHODS

This was a retrospective cohort study of adults on MV for 14 days or longer for acute respiratory failure at an academic medical center. Primary outcome was PT consultation by day 14 of MV. We examined associations between the following key predictors chosen a priori and PT consultation: age, tracheostomy, illness severity, oxygenation status, shock, hemodialysis, and medical service using multivariable logistic regression. Wilcoxon rank sum testing was used to test relationship between sedation and PT.

RESULTS

We identified 175 patients requiring PMV at our institution. Most were middle-aged (mean, 49.7 [SD, 18.5] years old) men (65%) with high illness severity (mean Acute Physiology and Chronic Health Evaluation III score, 86 [SD, 40]). Less than half of all patients requiring PMV (78/175, 45%) received PT consultation in the intensive care unit, and most failed to progress with therapy beyond range-of-motion exercises (85%). Failure to progress was associated with level of sedation (med Ramsay score 4.5 [interquartile range, 3-6] vs 3.5 [interquartile range, 3-5]; P = .01). Presence of a tracheostomy and prehospital nonambulatory status were associated with receipt of PT by day 14 of MV (odds ratio, 6.94 and 3.42, respectively; P ≤ .05).

CONCLUSIONS

In our study, we found that PT for PMV patients occurs infrequently and is generally of low intensity. Level of sedation, presence of a tracheostomy, and prehospital nonambulatory status were associated with receipt of PT consultation by day 14 of MV.