Neuro-orthopedics disorders in intensive care unit (ICU): Perceptions of teams

Abstract

Objective In intensive care unit (ICU), the frequent association of organ failure, neurological, orthopedic lesions and undernutrition promotes the development of neuro-orthopedic disorders (NOD). They can affect the acute phase management and the functional prognosis of patients. Caregivers (nurses and nursing auxiliaries) have a sentinel role in their early detection. Material/patients and methods We investigated the perception of paramedical and medical teams in 3 surgical ICU in university hospitals in Ile-de-France. Questionnaires were about the impact of the NOD on patient health and on care as well as on the therapeutic or preventive actions carried out. Results In total, 79 questionnaires including: nurses (n = 30, median age = 28.5 [23–49]), nursing auxiliaries (n = 17, median age = 31 [20–56]), doctors (n = 28, median age = 32.5 [24–60]) and physiotherapists (n = 4, median age = 50 [26–53]). Among caregivers, 64% have been working for less than 5 years in ICU and 46.8% consider NOD to be frequently responsible for pain. There is a correlation between age and the perception of NOD responsibility in pain for caregivers (P = 0.04), but not for doctors (P = 0.26). We do not find correlation between the experience in ICU and the perception of NOD responsibility in pain (P = 0.77), nor between the impact of NOD on pain and the tendency to start action against the NOD from caregivers (modification of the positioning P = 0.26 or mobilization by caregivers P = 0.57). Discussion – conclusion The number of responses seems to indicate that ICU teams are interested in NOD. Some results are surprising, with sometimes high variability. Although the methodology (question formulation, subjective declarative data, etc.) induces biases, we may wonder why age seems to influence the perception of the role of NOD in pain, contrary to the experience in ICU or why the pain does not seem to induce modifications of positioning or mobilization by the caregivers. It seems necessary to compare these data with a prospective study to determine the prevalence of NOD in ICU, or even to define a patient profile at risk of developing NOD in ICU.