Critically-ill Patients Research Articles

Effects of adjuvant ozone autohemotherapy combined with routine treatment on clinical and paraclinical features of mechanically ventilated COVID-19 patients in the intensive care unit: a pilot randomized controlled trial

Until the availability of an effective and practical vaccine, there is a serious need to recognize alternative treatments for coronavirus disease 2019 (COVID-19). This study aimed to determine whether major ozonated autohemotherapy (MOAH) can improve the clinical and paraclinical parameters in critically-ill patients with COVID-19 requiring mechanical ventilation. In this controlled trial, we enrolled 40 critically ill COVID-19 patients receiving invasive mechanical ventilation. The enrolled patients were then randomized into the MOAH and control groups. The patients in the MOAH group received MOAH three times per week (10 times in total) in addition to routine treatment and standard critical supportive care. Patients in the control group were only given regular treatment and standard critical supportive care. The patients in the MOAH group had more days of breathing with no aid than those in the control group. Moreover, the length of stay in the intensive-care unit was significantly lower in the MOAH group than in the control group. MOAH resulted in higher ventilation-free days and less intensive-care unit stay compared with the control treatment. In COVID-19 patients undergoing mechanical ventilation, MOAH with routine treatment resulted in more ventilator-free days and less intensive-care unit stay compared with the standard therapy.

Tocilizumab in ICU-admitted COVID-19 Patients: A Retrospective Study.

Severe and critically-ill COVID-19 patients are characterized by a severe inflammatory response. Pharmacologic inhibition of acute-phase inflammatory pathways such as IL-6 receptor inhibitor, Tocilizumab (TCZ) may improve patient outcomes in these cases. Consequently, the therapeutic benefit of TCZ was evaluated in this study. We evaluated intravenous tocilizumab in severe and critically ill adult COVID-19 patients who met pre-defined stringent CRS criteria. A single-center, prospective, observational cohort study was carried out among consecutive adult (≥18 years of age) in-patients with COVID-19 between March 20, 2020 and March 20, 2021. In total, 354 patients were included in our study. Mortality and time to hospital discharge were compared between patients who received tocilizumab treatment (n = 177) and those who did not (n = 177). A total of 354 patients were analyzed whereas 177 patients were included in each group. In those receiving TCZ, all-cause mortality was significantly reduced, corresponding to an adjusted hazard ratio (HR) of 0.57, (95% confidence interval (CI): 0.43-0.76; P < 0.001). Furthermore, time to discharge was significantly improved in the TCZ group (HR: 1.66; 95%CI: 1.17-2.36, P = 0.004). Invasive mechanical ventilation was not statistically different among the study groups after adjusting for confounding variables (HR: 1.38; 95%CI: 0.89-2.14; P = 0.139). Dosing frequency was independent of survival status (P = 0.676). The use of TCZ in ICU-hospitalized patients resulted in improved patient survival and reduced duration of hospitalization. Further studies are needed to confirm the efficacy of TCZ in severe and critical COVID-19 cases.

Colostrum supplement, IGF-1, and diarrhea in mechanically-ventilated patients: A double-blind, randomized, placebo-controlled study

BackgroundDiarrhea is relatively common in critically-ill mechanically-ventilated patients. This study investigated the effect of bovine colostrum supplement in the prevention of diarrhea. MethodsMechanically-ventilated patients expected to require enteral nutrition for at least five days were randomly assigned to the intervention or placebo groups. The intervention group received enteral diet providing 30g of bovine colostrum daily, and the control group received a similar diet except for whey protein as a placebo. The duration of the intervention was ten days. Serum levels of IGF-1 were measured at baseline and the end of the intervention. Patients were followed up for the occurrence of diarrhea. ResultsOut of 136 participants, 45 patients in the colostrum group and 45 patients in the control group were included in the final analysis of the outcomes. Plasma IGF-1 concentration increased significantly in the colostrum group after the intervention (P=0.02). In the between-group comparison, the increase in IGF-1 was significantly higher in the colostrum group compared with the placebo group (P=0.04). Furthermore, the incidence of diarrhea was significantly lower in the colostrum group compared to the control group. ConclusionBovine colostrum supplementation increased serum levels of IGF-1 and may reduce the incidence of diarrhea in critically-ill mechanically-ventilated patients.

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury

Abstract Cardiac surgery performed on patients in cardiogenic shock is associated with a high mortality and morbidity. Preoperative Extra Corporeal Membrane Oxygenation (ECMO) in cardiogenic shock gives critically-ill patients a chance for surgical intervention and is associated with better surgical outcomes. We present a 29-year-old male who had a ventricular septal defect closure as a child and presented with multi-organ injuries following polytrauma. He was in cardiogenic shock despite maximal inotropic support. Transesophageal echocardiography demonstrated torrential tricuspid regurgitation (TR) from a flail tricuspid valve (TV) leaflet as the cause of cardiogenic shock. He was stabilized on Veno-Arterial ECMO and underwent reoperative cardiac surgery. Intra-operatively, the anterior leaflet of his TV and its papillary muscle was detached from the right ventricle. He had a successful tissue TV replacement. Early surgery was indicated to treat right ventricular failure due to torrential TR, but due to his restricting non-cardiac injuries, ECMO was successfully used as a short-term support strategy and as a bridge to definitive surgery.

Alisol B 23-acetate broadly inhibits coronavirus through blocking virus entry and suppresses proinflammatory T cells responses for the treatment of COVID-19

IntroductionEmerging severe acute respiratory syndrome (SARS) coronavirus (CoV)-2 causes a global health disaster and pandemic. Seeking effective anti-pan-CoVs drugs benefit critical illness patients of coronavirus disease 2019 (COVID-19) but also may play a role in emerging CoVs of the future. ObjectivesThis study tested the hypothesis that alisol B 23-acetate could be a viral entry inhibitor and would have proinflammatory inhibition for COVID-19 treatment. MethodsSARS-CoV-2 and its variants infected several cell lines were applied to evaluate the anti-CoVs activities of alisol B 23-aceate in vitro. The effects of alisol B 23-acetate on in vivo models were assessed by using SARS-CoV-2 and its variants challenged hamster and human angiotensin-converting enzyme 2 (ACE2) transgenic mice. The target of alisol B 23-acetate to ACE2 was analyzed using hydrogen/deuterium exchange (HDX) mass spectrometry (MS). ResultsAlisol B 23-acetate had inhibitory effects on different species of coronavirus. By using HDX-MS, we found that alisol B 23-acetate had inhibition potency toward ACE2. In vivo experiments showed that alisol B 23-acetate treatment remarkably decreased viral copy, reduced CD4+ T lymphocytes and CD11b+ macrophages infiltration and ameliorated lung damages in the hamster model. In Omicron variant infected human ACE2 transgenic mice, alisol B 23-acetate effectively alleviated viral load in nasal turbinate and reduced proinflammatory cytokines interleukin 17 (IL17) and interferon γ (IFNγ) in peripheral blood. The prophylactic treatment of alisol B 23-acetate by intranasal administration significantly attenuated Omicron viral load in the hamster lung tissues. Moreover, alisol B 23-acetate treatment remarkably inhibited proinflammatory responses through mitigating the secretions of IFNγ and IL17 in the cultured human and mice lymphocytes in vitro. ConclusionAlisol B 23-acetate could be a promising therapeutic agent for COVID-19 treatment and its underlying mechanisms might be attributed to viral entry inhibition and anti-inflammatory activities.

ETIOLOGY OF SEPSIS AND CARDIAC DYSFUNCTION AMONG CRITICALLY ILL PATIENTS WITH SEPSIS AND SEPTIC SHOCK

ETIOLOGY OF SEPSIS AND CARDIAC DYSFUNCTION AMONG CRITICALLY ILL PATIENTS WITH SEPSIS AND SEPTIC SHOCK

PB1034 Monitoring of Argatroban in Critical Ill Patients: A Prospective Study Comparing aPTT, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and dTT to LC/MS/MS

PB1034 Monitoring of Argatroban in Critical Ill Patients: A Prospective Study Comparing aPTT, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and dTT to LC/MS/MS

Effectiveness of Lactate Clearance to Predict In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding.

To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB). Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022. This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay. The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB. Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning. Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

Association of Neutrophilia with Disease Severity in Patients with COVID-19

COVID-19 has become a global pandemic with limited data on prediction of disease severity and management of critically-ill patients. Objective: To assess associations between routine Haematologica parameters especially neutrophil counts and severity in COVID-19 patients. Methods: The study was a cross-sectional study involving 133 non-severe and 120 severe category patients. This study was conducted at Chughtai Institute of Pathology from 1st June till 31st August, 2020. The association of severity with parameters was determined using Chi-square and Fisher´s Exact test. Results: Absolute Neutrophil Count (ANC) and NLR were significantly higher in Severe Group category. Neutrophilia and raised NLR were observed in 81.7% and 93% of the severe group respectively. Lymphopenia was observed in only 36.7% of Severe Group. Comorbidities such as, hypertension (82,1%), diabetes (85.5%), IHD (100%) and COPD (83.9%) had significantly high frequency of increased NLR. Also, clinical symptoms like fever (77.9%), cough (80.9%), shortness of breath (94.3%) and abdominal symptoms (88.2%) also had same significant association. Conclusions: It was observed that high NLR ≥ 3 was associated with severe disease along with high ANC. However, lymphopenia as expected, was not observed in significant population. Instead, neutrophilia was a more consistent finding in the concerned group.

Nutritional and metabolic support in critically-ill patients with COVID-19 disease: A multicenter cohort study

Nutritional and metabolic support in critically-ill patients with COVID-19 disease: A multicenter cohort study

In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure.

A high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in-hospital change in RDW (∆RDW) remains debatable. We included 5514 patients with critical illness and HF from the MIMIC-IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all-cause mortality at 90day, 180day, and 1year after discharge. The median age of the patients was 73.91years, and 46.37% were women. Kaplan-Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all-cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all-cause mortality at 90day, 180day, and 1year after adjusting for confounding factors (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.13-1.21, P<0.001; HR=1.17, 95% CI=1.14-1.20, P<0.001; and HR=1.18, 95% CI=1.15-1.20, P<0.001, respectively). Restricted cubic splines showed a non-linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre-specified subgroups. Our study suggests that an increased RDW during hospitalization is independently associated with short- or long-term all-cause mortality in critical-ill patients with HF.

Central Line Associated Bloodstream Infections in Critical Ill Patients during and before the COVID-19 Pandemic.

(1) Background: The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the rates of central line-associated bloodstream infections (CLABSI), its etiology, and risk factors in critically ill patients, because Slovakia was one of the countries experiencing a high burden of COVID-19 infections, and hospitals faced greater challenges in preventing and managing CLABSI; (2) Methods: A retrospective analysis of CLABSI data from all patients admitted to adult respiratory intensive care units before and during COVID-19 pandemic was conducted. We followed the guidelines of the Center for Disease Control surveillance methodology for CLABSI. Data were analyzed using STATISTICA 13.1; (3) Results: We analyzed the data of 803 ICU patients hospitalized for 8385 bed days, with 7803 central line days. Forty-five CLABSI events were identified. The CLABSI rate significantly increased during the COVID-19 pandemic compared to before the COVID-19 pandemic (2.81 versus 7.47 events per 1000 central line days, (p < 0.001). The most frequently identified pathogens causing CLABSI were Gram-negative organisms (60.20%). The risk factors found to increase the probability of developing CLABSI were length of stay (OR = 1.080; 95% Cl: 1.057-1.103; p < 0.001) and COVID-19 (OR = 5.485; 95% Cl: 32.706-11.116; p < 0.001). (4) Conclusions: The COVID-19 pandemic was associated with increases in CLABSI in ICUs. These data underscore the need to increase efforts in providing surveillance of CLABSI and implementing infection prevention measures.

Effect of Awake Prone Positioning on ROX Index in Critically-ill Patients With Respiratory Failure due to COVID-19.

COVID-19 pneumonia causes acute respiratory distress syndrome (ARDS). Prone positioning (PP) is beneficial to pulmonary physiology and improves oxygenation in patients with ARDS. We aimed to investigate the effect of the PP on oxygenation, respiratory rate (RR) and ROX index in non-intubated patients with COVID-19 associated respiratory failure and to determine whether ROX index predicts intubation. Awake critically-ill patients with confirmed diagnosis of COVID-19 who underwent PP were enrolled in the retrospective, single-center study. Oxygenation parameters were recorded 1 h before PP, during PP and 1 h after return to supine position (after PP). Intubation was defined as the endpoint. Seventy-one patients with a median age of 64 [55-73] years were enrolled in the study. PaO2/FiO2 and SpO2/FiO2 improved during PP, this improvement did not persist after PP. RR improved during and after PP in both intubated and non-intubated patients (for all P < .001). ROX index improved only in non-intubated patients (P < .001) but not in intubated patients (P = .07). Area under the curve (AUC) of ROX index for intubation before PP, during PP and after PP were 0.74 [0.61-0.88] (P = .002), 0.76 [0.62-0.91] (P = .001), and 0.76 [0.64-0.89] (P = .001), respectively. ROX index >6.83 before PP had a negative predictive value (NPV) of 0.85; ROX index >8.28 during PP had a NPV of 0.88 and ROX index >7.48 after PP had a NPV of 0.85. In logistic regression adjusted for APACHE II score, ROX index ≤6.83 before PP had an odds ratio (OR) 4.47 [1.39-14.38], ROX index ≤8.28 during PP had an OR 7.96 [2.29-27.64] and ROX index ≤7.48 had an OR 3.98 [1.25-12.61] for prediction of intubation. In conclusion, awake PP improves oxygenation and decreases RR. ROX index improved only in non- intubated patients and a higher ROX index predicts lower risk of progressing to mechanical ventilation with intubation.

Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone—a registry based evaluation

IntroductionSickle cell disease (SCD) in pregnancy is associated with worse maternal and neonatal outcomes. There is limited available data describing the burden and outcomes of critically ill obstetric patients affected by SCD in low-income settings.ObjectivesWe aimed to define SCD burden and impact on mortality in critically-ill obstetric patients admitted to an urban referral hospital in Sierra Leone. We hypothesized that SCD burden is high and independently associated with increased mortality.MethodsWe performed a registry-based cross-sectional study from March 2020 to December 2021 in the high-dependency unit (HDU) of Princess Christian Maternity Hospital PCMH, Freetown. Primary endpoints were the proportion of patients identified in the SCD group and HDU mortality. Secondary endpoints included frequency of maternal direct obstetric complications (MDOCs) and the maternal early obstetric warning score (MEOWS).ResultsOut of a total of 497 patients, 25 (5.5%) qualified to be included in the SCD group. MEOWS on admission was not different between patients with and without SCD and SCD patients had also less frequently reported MDOCs. Yet, crude HDU mortality in the SCD group was 36%, compared to 9.5% in the non SCD group (P < 0.01), with an independent association between SCD group exposure and mortality when accounting for severity on admission (hazard ratio 3.40; 95%CI 1.57—7.39; P = 0.002). Patients with SCD had a tendency to longer HDU length of stay.ConclusionsOne out of twenty patients accessing a HDU in Sierra Leone fulfilled criteria for SCD. Despite comparable severity on admission, mortality in SCD patients was four times higher than patients without SCD. Optimization of intermediate and intensive care for this group of patients should be prioritized in low-resource settings with high maternal mortality.

Increased inflammatory mediators levels are associated with clinical outcomes and prolonged illness in severe COVID-19 patients

ObjectiveThe purpose of this study was to identify potential predictors of clinical outcome in severe COVID-19 patients and to investigate the relationship between immunological parameters and duration of illness. MethodsThis single-center study retrospectively recruited 73 patients with severe or critical COVID-19. Immunological indicators include white blood cell count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and circulating inflammatory mediators were observed for their association with disease severity, mortality and duration of illness of COVID-19. ResultsSerum inflammatory mediators levels of C-reactive protein (P = 0.015), interleukin 6 (IL-6) (P < 0.001), CX3CL1 (P < 0.001), D-dimer (P < 0.001) and procalcitonin (PCT) (P < 0.001) were increased in critical illness patients compared to those severe COVID-19 patients. CX3CL1 has the highest C-index (0.75) to predict in-hospital mortality in patients with COVID-19. Furthermore, this study shows for the first time that the duration of illness in severe COVID-19 patients is associated with serum levels of CX3CL1 (P = 0.037) and D-dimer (P = 0.014). ConclusionCX3CL1, D-dimer, PCT, and IL-6 could effectively predict mortality in severe COVID-19 patients. In addition, only the circulating levels of CX3CL1 and D-dimer were significantly associated with duration of illness.

Comparison of microbial colonization rates between central venous catheters and peripherally inserted central catheters

BackgroundCentral venous catheters (CVCs) and peripherally inserted central catheters (PICCs), have been widely used as intravascular devices in critically ill patients. However, they might evoke complications, such as catheter colonization that has been considered as predisposing factor for central line-associated bloodstream infections (CLABSIs). Although numerous studies have compared the risk of bloodstream infections between PICCs and CVCs, comparative studies on their colonization rates are limited.ObjectivesThe episodes of catheter colonization in critically ill patients with CVCs or PICCs were retrospectively analysed during a two-year period in a Greek tertiary care hospital and colonization rates, microbial profiles and antimicrobial susceptibility patterns were compared.MethodsClinical and laboratory data of consecutive hospitalized critically-ill patients who underwent PICC and CVC placement between May 2017–May 2019 were analysed. All catheters were examined by the semiquantitative culture technique for bacterial pathogens, either as a routine process after catheter removal or after suspicion of infection. Species identification and antimicrobial resistance patterns were determined by the Vitek2 automated system.ResultsDuring the survey period a total of 122/1187 (10.28%) catheter colonization cases were identified among CVCs and 19/639 (2.97%) cases among PICCs (p = 0.001). The colonization rate was 12.48/1000 catheter-days for the CVC group and 1.71/1000 catheter-days for the PICC group (p < 0.001). The colonization rate per 1000 catheter-days due to multidrug-resistant organisms (MDROs) was 3.85 in all study cases, 7.26 (71/122) in the CVC group and 0.63 (7/19) in the PICC group (p < 0.001). Within the CVC group, the most common microorganism isolated was MDR Acinetobacter baumannii (n = 38, 31.1%) followed by MDR Klebsiella pneumoniae (n = 20, 16.4%). In the PICC group, the predominant microorganism isolated was Candida spp. (n = 5, 23.8%) followed by MDR K. pneumoniae and MDR A. baumannii in equal numbers (n = 3, 14.2%).ConclusionPICC lines were associated with significantly lower colonization rates comparing to the CVC ones. In addition, patterns of microbial colonization revealed a trend over the predominance of MDR gram-negatives in CVCs suggesting that PICCs might be a safer alternative for prolonged inpatient intravascular access. Prevention programs directed by local microbial ecology may diminish catheter colonization rates and CLABSIs.

Restrictive fluid management and early fluid de-escalation versus usual care in critically ill patients: A feasibility trial protocol for the REDUCE randomized clinical trial

Background: Fluid therapy is an essential therapeutic intervention for critically ill patients. Both fluid overload and hypovolemia are associated with poor outcomes. However, the fluid strategy in intensive care units is still controversial, and there is no consensus on using the fluid strategy in patients with circulatory shock. Objectives: To compare the efficacy of protocol-based fluid-restrictive management versus standard care in critically ill patients with circulatory shock. Methods: This is a single-center, feasibility-based, randomized, controlled trial in critically ill patients with circulatory shock receiving either fluid resuscitation or vasopressors in two medical ICUs at Siriraj Hospital. Eligible patients will be randomly allocated in a 1:1 ratio and placed in the restrictive fluid strategy (intervention) group or standard care (control) group. The primary outcome is accumulative fluid balance 72 hours after enrollment. Conclusions: This study will evaluate the efficacy and safety of a protocol-based fluid restrictive strategy in critically ill patients who have circulatory shock and are receiving fluid resuscitation or vasopressors.

Association of Blood Pressure Variability With Death and Discharge Destination Among Critically Ill Patients With and Without Stroke.

It is unclear whether blood pressure variability's (BPV) association with worse outcomes is unique to patients with stroke or a risk factor among all critically ill patients. We (1) determined whether BPV differed between patients with stroke and nonstroke patients, (2) examined BPV's associations with in-hospital death and favorable discharge destination in patients with stroke and nonstroke patients, and (3) assessed how minimum mean arterial pressure (MAP)-a correlate of illness severity and cerebral perfusion-affects these associations. This is a retrospective analysis of adult intensive care unit patients hospitalized between 2001 and 2012 from the Medical Information Mart for Intensive Care III database. Confounder-adjusted logistic regressions determined associations between BPV, measured as SD and average real variability (ARV), and (1) in-hospital death and (2) favorable discharge, with testing of minimum MAP for effect modification. BPV was higher in patients with stroke (N = 2,248) compared with nonstroke patients (N = 9,085) (SD mean difference 2.3, 95% CI 2.1-2.6, p < 0.01). After adjusting for minimum tertile of MAP and other confounders, higher SD remained significantly associated (p < 0.05) with higher odds of in-hospital death for patients with acute ischemic strokes (AISs, odds ratio [OR] 2.7, 95% CI 1.5-4.8), intracerebral hemorrhage (ICH, OR 2.6, 95% CI 1.6-4.3), subarachnoid hemorrhage (SAH, OR 3.4, 95% CI 1.2-9.3), and pneumonia (OR 1.9, 95% CI 1.1-3.3) and lower odds of favorable discharge destination in patients with ischemic stroke (OR 0.3, 95% CI 0.2-0.6) and ICH (OR 0.4, 95% CI 0.3-0.6). No interaction was found between minimum MAP tertile with SD (p > 0.05). Higher ARV was not significantly associated with increased risk of death in any condition when adjusting for illness severity but portended worse discharge destination in those with AIS (OR favorable discharge 0.4, 95% CI 0.3-0.7), ICH (OR favorable discharge 0.5, 95% CI 0.3-0.7), sepsis (OR favorable discharge 0.8, 95% CI 0.6-1.0), and pneumonia (OR favorable discharge 0.5, 95% CI 0.4-0.8). BPV is higher and generally associated with worse outcomes among patients with stroke compared with nonstroke patients. BPV in patients with AIS and patients with ICH may be a marker of central autonomic network injury, although clinician-driven blood pressure goals likely contribute to the association between BPV and outcomes.

The Effect of Early Mobilization on Functional Status of Stroke Patients: A Literature Review

Stroke impact to the altering functional status. Early mobilization is one of stroke care components that can minimize impact due to altering functional status such as weakness and paralysis in stroke patients. The review of early mobilization was proved increasing the functional status among critical illness patients. Limited review regarding the effect of early mobilization on changes in the level of functional status of stroke patients The aim the study was to determine the effect of early mobilization at the level of functional status of stroke patients. This research used the literature review with the MeSH search tool. The keywords and syntax included "stroke", "early mobilization", and "functional status". Articles found with keywords early mobilization; functional status; stroke retrieve 12,114 articles, namely 2069 articles from Proquest, 4774 articles from Pubmed, 35 articles from Scopus, and 5236 articles from ScienceDirect which were filtered based on the specified criteria and obtained 10 articles for review published in the period 2011-2021, with patient research samples strokes. The effect of early mobilization mostly showedan increasing degree of functional status level among stroke patients. It is recommended to provide early mobilization among stroke patient. Future research should conduct a meta-analysis in analysing effect of early mobilisation among stroke patients.

The Effect of Early Mobilization on Functional Status of Stroke Patients: A Literature Review

Stroke impact to the altering functional status. Early mobilization is one of stroke care components that can minimize impact due to altering functional status such as weakness and paralysis in stroke patients. The review of early mobilization was proved increasing the functional status among critical illness patients. Limited review regarding the effect of early mobilization on changes in the level of functional status of stroke patients The aim the study was to determine the effect of early mobilization at the level of functional status of stroke patients. This research used the literature review with the MeSH search tool. The keywords and syntax included "stroke", "early mobilization", and "functional status". Articles found with keywords early mobilization; functional status; stroke retrieve 12,114 articles, namely 2069 articles from Proquest, 4774 articles from Pubmed, 35 articles from Scopus, and 5236 articles from ScienceDirect which were filtered based on the specified criteria and obtained 10 articles for review published in the period 2011-2021, with patient research samples strokes. The effect of early mobilization mostly showedan increasing degree of functional status level among stroke patients. It is recommended to provide early mobilization among stroke patient. Future research should conduct a meta-analysis in analysing effect of early mobilisation among stroke patients.