Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning.

PURPOSE: 20% of patients with mechanical ventilation (MV) have a prolonged, complex weaning process, often experiencing a condition of ICU-acquired weakness (ICUAW), with a severe decrease in muscle function and restricted long-term prognosis. We aimed to analyze a protocolized, systematic approach of physiotherapy in prolonged weaning patients and hypothesized that the duration of weaning from MV would be shortened. METHODS: ICU patients with prolonged weaning were included before (group 1) and after (group 2) introduction of a quality control measure of a structured and protocolized physiotherapy program. Primary endpoint was the tested dynamometric handgrip strength and the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS). Secondary endpoints were weaning success rate, ventilator-free days, hospital mortality, the prevalence of ICUAW, infections and delirium. RESULTS: 106 patients were included. Both the SOMS and the handgrip test were significantly improved after introducing the program. Despite no differences in weaning success rates at discharge, the total length of MV was significantly shorter in group 2, which also had lower prevalence of infection and higher probability of survival. CONCLUSIONS: Protocolized, systematic physiotherapy resulted in an improvement of the clinical outcome in patients with prolonged weaning. Results were objectifiable with the SOMS and the handgrip test.

Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study.

OBJECTIVE: To examine the effect of pressure ulcers in older patients on the length of stay in hospital. BACKGROUND: Previous research on this topic did not focus solely on older people. A growing number of older people require hospital admission. DESIGN: A retrospective observational study. METHODS: Data of 3198 patients age 75 years and older were included. The setting was a 1350-bed German University Hospital. Data were drawn from quality indicator data recorded by nurses. The independent effect of pressure ulcers was analysed using a multivariate Poisson-Regression model. RESULTS: Of the participants, 7·1% had an ulcer during their hospitalisation. 87·3% were classified as categories I and II. Mean age was 81·6 years for all patients and 83·2 years for pressure ulcer patients. Pressure ulcer patients had a longer overall hospital stay (19·0 vs. 9·9 days) and a higher excess length of stay (2·6 vs. 0·3 days). Pressure ulcers had a statistically significant effect (p = 0·0011) on the increase in length of stay. The impact of hospital acquired pressure ulcers on length of stay was more pronounced compared to those ulcers being present on admission. The pressure ulcer category was not significant. CONCLUSIONS: Pressure ulcers during hospitalisation are an independent and significant predictor of a prolonged inpatient stay for elderly patients. This study indicates that besides complications and co-morbidities social factors, as well as the hospital's internal processes of patient care, also can play a significant role. RELEVANCE TO CLINICAL PRACTICE: To evaluate the distinct role of hospital acquired pressure ulcers further research is needed. The elderly patients in this study were a heterogeneous group. The implementation of clinical and nursing processes for both the 'fit' and the 'sick' geriatric patients is an important challenge.