Lauren Bright1, Lisa van der Lee2,3, Dana Hince7, Fiona Wood4,6, Dale Edgar2,4,5,6
1 The University of Notre Dame Australia, Fremantle Western Australia, Australia
2 Physiotherapy Department, Fiona Stanley Hospital, Murdoch Western Australia, Australia
3 Intensive Care Unit, Fiona Stanley Hospital, Murdoch Western Australia, Australia
4 State Adult Burn Unit, Fiona Stanley Hospital, Murdoch Western Australia, Australia
5 Burn Injury Research Node, The University of Notre Dame Australia, Fremantle Western Australia, Australia
6 Fiona Wood Foundation, Murdoch Western Australia, Australia
7 Institute for Health Research, The University of Notre Dame Australia, Fremantle Western Australia, Australia
Early rehabilitation for severe burns survivors is arguably more challenging than the general intensive care population. Early achievement of verticality has the potential to address the detrimental effects of immobility identified in ICU patients and reduce healthcare costs. However, achieving functional verticality is influenced by acute skin reconstruction, sedation practices and cardiovascular stability during the acute intensive care period.
The aim of this study was to identify the impact of sedation and inotropic support on cessation of bed rest in burns patients admitted to ICU.
A retrospective observational cohort study was conducted. The digital medical records were reviewed to explore episodes of functional verticality and the impact of inotrope and sedation practices and mechanical ventilation. Logistic regression was used to examine the association between inotropic support and sedation levels on the achievement of verticality for patients who survived ICU admission.
Data for 64 subjects indicated that daily maximum noradrenaline dose increases of 1mL/hr are associated with a 14% reduction in odds of achieving verticality. When sedation is within recommended limits, odds of achieving verticality milestones increase 20.83 times compared to periods outside those limits.
Discussion and Conclusion
High sedation scores, sedative infusion and inotropic support pose significant limitation on early and frequent mobilisation in burns patients admitted to ICU. Additional barriers are mechanical ventilation and burns surgery. The challenge for clinicians moving forward is to determine which of these factors are modifiable in order to increase early mobilisation of burn patients in ICU.
 Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;2:171-83.
 Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults 2014.
 Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, et al. Monitoring Sedation Status Over Time in ICU Patients: Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;22:2983-91.
Lauren Bright is a Physiotherapist and recent graduate from The University of Notre Dame Australia, Fremantle.