Most Proposed Topic :
HA Young Investigators Session (projects to be presented by and HA staff who had joined HA for less than 15 years)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors: (including presenting author): :
Tsang CLT(1), Or SK(1), Chan HL(1), Wong YY(1), Pan JJ(1), Ma W(1), Soo WL(1), Ip WH(1), Kwong SF(1),
Chan CSS(2), Lee PO(2), TSE KY(2), YU SYJ(2) Yeung WT(2)
Affiliation: :
(1) Physiotherapy Department RTSKH, (2) Intensive Care Unit (ICU), Department of Medicine & Geriatrics, RTSKH
Introduction: :
Patients in Intensive Care Unit (ICU) are at high risk of developing neuro-myopathy due to prolonged mechanical ventilation, multi-organ failure and sepsis.1 Evidence recommended that early mobilization would be beneficial.2 With the promising results from other clusters, ICU early mobilization has been implemented in RH 2023/24 annual plan and launched in April 2023.
Objectives: :
- To provide early mobilization to ICU patients at risk of ICU-acquired weakness
- To improve patients’ muscle strength and functional status
- To reduce complications due to prolonged immobilization
Methodology: :
Richmond Agitation Sedation Scale (RASS) is recommended to stratify ICU patients into four mobility levels. Further to the conventional chest physiotherapy, early mobilization with neuromuscular stimulation, exercise and mobility training were provided. Meanwhile, ICU Mobility Scale (ICUMS) and Medical Research Council Sum Score (MRCSS) were selected as the outcome measures to assess patients’ mobility and power. Data was collected upon admission and discharge from ICU.
Result & Outcome: :
From April to November 2023, 780 early mobilization sessions were offered to 161 ICU patients. The pre- and post-data of ICUMS & MRCSS were obtained from 123 patients, by excluding 38 patients who attended only a single session before discharge from ICU.
ICU Mobility Scale (ICUMS)
Upon admission, majority of patients (83.7%) could only receive exercise on bed which was presented as score 0 or 1 in ICUMS. While at the time of ICU discharge, only 33% of the patients remain “exercise on bed”. The majority (50.4%) were able to participate bed to chair transfer or walking exercise with ICUMS scored from 5 to 10.
Medical Research Council Sum Score (MRCSS)
MRCSS < 48 was an indicator of ICU acquired weakness. On ICU admission, 51.2% showed MRCSS < 48 as the pre data. The post data dropped to 32.5% upon ICU discharge, showing a reduction in risk of ICU acquired weakness.
Conclusion
The ICU early mobilization program provided relevant stratified physiotherapy service to patients. Reduction in risk of ICU acquired weakness and improvement of mobility status of patients were demonstrated. Further studies are suggested to evaluate the beneficial effects of ICU early mobilization among different disease types to subgroup analysis.
