Abstract
IntroductionIntensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Although ICU-AW is well described subjectively in the literature, the value of objective measures has yet to be established. This project aimed to evaluate the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing the association between CPAx scores and hospital-discharge location, as a measure of functional outcome.MethodsThe CPAx was integrated into practice as a service-improvement initiative in an 11-bed intensive care unit (ICU). For patients admitted for more than 48 hours, between 10 May 2010 and 13 November 2013, the last CPAx score within 24 hours of step down from the ICU or death was recorded (n = 499). At hospital discharge, patients were separated into seven categories, based on continued rehabilitation and care needs. Descriptive statistics were used to explore the association between ICU discharge CPAx score and hospital-discharge location.ResultsOf the 499 patients, 171 (34.3%) returned home with no ongoing rehabilitation or care input; 131 (26.2%) required community support; 28 (5.6%) went to inpatient rehabilitation for <6 weeks; and 25 (5.0%) went to inpatient rehabilitation for >6 weeks; 27 (5.4%) required nursing home level of care; 80 (16.0%) died in the ICU, and 37 (7.4%) died in hospital. A significant difference was found in the median CPAx score between groups (P < 0.0001). Four patients (0.8%) scored full marks (50) on the CPAx, all of whom went home with no ongoing needs; 16 patients (3.2%) scored 0 on the CPAx, all of whom died within 24 hours. A 0.8% ceiling effect and a 3.2% floor effect of the CPAx is found in the ICU. Compliance with completion of the CPAx stabilized at 78% of all ICU admissions.ConclusionThe CPAx score at ICU discharge has displayed construct validity by crudely discriminating between groups with different functional needs at hospital discharge. The CPAx has a limited floor and ceiling effect in survivors of critical illness. A significant proportion of patients had a requirement for postdischarge care and rehabilitation.
Highlights
Intensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit
* Correspondence: e.corner13@imperial.ac.uk 1Clinical Lead Respiratory Physiotherapist and Clinical Research Fellow, Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England 2Imperial College London, London, UK Full list of author information is available at the end of the article. These pathophysiologic changes lead to measurable impairment of muscle strength associated with disability and functional decline, often coupled with a reduction in health-related quality of life [3]. This syndrome is commonly known as Intensive Care Unit-Acquired Weakness (ICU-AW)
The Chelsea Critical Care Physical Assessment tool (CPAx) was integrated into clinical practice, through an iterative process of plan do study act (PDSA) cycles, adopted from service-improvement methods
Summary
Intensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Multiorgan failure, along with its associated immobility and inflammatory state, leads to rapid and significant muscle loss, which can reach up to 15% within 7 days [1,2] This is due to a reduction in protein synthesis and increased protein breakdown, as well as myofibril necrosis [1]. These pathophysiologic changes lead to measurable impairment of muscle strength associated with disability and functional decline, often coupled with a reduction in health-related quality of life [3]. This syndrome is commonly known as Intensive Care Unit-Acquired Weakness (ICU-AW). With around 110,000 patients admitted to ICUs in England and Wales annually, this public health issue that extends well beyond the walls of the ICU [4,5], and we have no reason to conclude that this would be different in other countries
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