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Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study
BACKGROUND: Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation pr...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700948/ https://www.ncbi.nlm.nih.gov/pubmed/36434724 http://dx.doi.org/10.1186/s13054-022-04245-0 |
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author | Lindholz, Maximilian Schellenberg, Clara M. Grunow, Julius J. Kagerbauer, Simone Milnik, Annette Zickler, Daniel Angermair, Stefan Reißhauer, Anett Witzenrath, Martin Menk, Mario Boie, Sebastian Balzer, Felix Schaller, Stefan J. |
author_facet | Lindholz, Maximilian Schellenberg, Clara M. Grunow, Julius J. Kagerbauer, Simone Milnik, Annette Zickler, Daniel Angermair, Stefan Reißhauer, Anett Witzenrath, Martin Menk, Mario Boie, Sebastian Balzer, Felix Schaller, Stefan J. |
author_sort | Lindholz, Maximilian |
collection | PubMed |
description | BACKGROUND: Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation. METHODS: We conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs. RESULTS: A total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI − 0.09, − 0.05; p ≤ 0.001) and early mobilisation (adjusted OR 0.83; 95% CI 0.76, 0.90; p ≤ 0.001), while a higher norepinephrine dose corresponded to a lower chance to be mobilised out-of-bed (adjusted OR 0.01; 95% CI 0.00, 0.04; p ≤ 0.001). Mobilisation with norepinephrine did not significantly affect mortality (p > 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 µg/kg/min norepinephrine for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation. CONCLUSIONS: Mobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 µg/kg/min for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04245-0. |
format | Online Article Text |
id | pubmed-9700948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-97009482022-11-27 Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study Lindholz, Maximilian Schellenberg, Clara M. Grunow, Julius J. Kagerbauer, Simone Milnik, Annette Zickler, Daniel Angermair, Stefan Reißhauer, Anett Witzenrath, Martin Menk, Mario Boie, Sebastian Balzer, Felix Schaller, Stefan J. Crit Care Research BACKGROUND: Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation. METHODS: We conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs. RESULTS: A total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI − 0.09, − 0.05; p ≤ 0.001) and early mobilisation (adjusted OR 0.83; 95% CI 0.76, 0.90; p ≤ 0.001), while a higher norepinephrine dose corresponded to a lower chance to be mobilised out-of-bed (adjusted OR 0.01; 95% CI 0.00, 0.04; p ≤ 0.001). Mobilisation with norepinephrine did not significantly affect mortality (p > 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 µg/kg/min norepinephrine for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation. CONCLUSIONS: Mobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 µg/kg/min for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04245-0. BioMed Central 2022-11-25 /pmc/articles/PMC9700948/ /pubmed/36434724 http://dx.doi.org/10.1186/s13054-022-04245-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Lindholz, Maximilian Schellenberg, Clara M. Grunow, Julius J. Kagerbauer, Simone Milnik, Annette Zickler, Daniel Angermair, Stefan Reißhauer, Anett Witzenrath, Martin Menk, Mario Boie, Sebastian Balzer, Felix Schaller, Stefan J. Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title | Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title_full | Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title_fullStr | Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title_full_unstemmed | Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title_short | Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
title_sort | mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700948/ https://www.ncbi.nlm.nih.gov/pubmed/36434724 http://dx.doi.org/10.1186/s13054-022-04245-0 |
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