Proposals by Paramedical Staff to Initiate Rehabilitation in Patients with Critical Illness on Mechanical Ventilation Acknowledgements This study was approved by the Ethical Committee for Epidemiology of Hiroshima University. Presented at the WCPT Congress 2015, Singapore. References 1) Schweickert WD, et al.: Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 373: ) Engel HJ, et al.: Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther., 93: Participants Consecutive patients on mechanical ventilation ≧ 24 hours, who were admitted to the ICU at Hiroshima University Hospital between April 2011 and March 2014 and received PT. Introduction Early rehabilitation improves the functional outcome of patients with critical illnesses 1. On the other hand, delayed physical therapy (PT) consult is one of the barriers to the delivery of physical therapy in the intensive care unit (ICU) 2. The effect of proposals that PT will be initiated in patients with critical illness is unclear. MethodsResults Discussion & Conclusions This result may indicate that the proposals by paramedical staff to initiate physical therapy for patients on mechanical ventilation can reduce the days until start of rehabilitation, days until the patient is able to get out of bed and the length of stay in the ICU. Table 2. Function outcomes Figure 2. Clinical outcomes Purpose To assess whether initiating PT, as proposed by paramedical staff to physicians, can shorten the number of bedridden days and the length of stay in the ICU. Contact details Sasaki Kosuke Control (n=107) Intervention (n=246) P Value Age (y), Mean ± SD 61.4 ± ± Female, n (%) 29 (27.1%)89 (36.2%) APACHE Ⅱ score, Mean ± SD 24.5 ± ± BMI, Mean ± SD 22.7 ± ± Charlson comorbidity index, Mean ± SD 1.9 ± ± ICD-10 at the ICU admission Trauma 29.7%38.4% Cardiovascular 22.1%15.2% Respiratory 10.8%14.2% Certain infectious and parasitic diseases 6.9% 6.6% gastrointestinal 6.6% 5.7% Other 30.8%26.5% Table 1. Baseline characteristics Control (n=107) Intervention (n=246) P Value Time to initiating PT (d) 9.0 ± ± 2.5 <0.001 Number of patients who could be out of the bed 68 (63.6%)180 (73.2%) Time to 1st out of the bed (d) 14.0 ± ± Time from ICU admission to milestone achieved (d) dangle 13.8 ± 10.9 (n=52, 48.6%) 12.3 ± 15.3 (n=138, 56.1%) transfer to the wheelchair 17.5 ± 13.4 (n=44, 41.1%) 12.5 ± 9.3 (n=112, 45.5%) standing 20.2 ± 19.0 (n=35, 32.7%) 11.9 ± 8.9 (n=103, 41.9%) walking 23.8 ± 22.6 (n=21, 19.6%) 16.0 ± 24.4 (n= 66, 26.8%) Physician Paramedical staff PT Program Figure 1. Proposal by paramedical staff to initiate rehabilitation consultation 【 Control group 】 【 Intervention group 】 Proposal to initiate rehabilitation consultation Sasaki K. 1, Sarada K. 2, Taito S. 2, Kawae T. 2, Sekikawa K. 3, Wada M. 4, Watanabe T. 3, Hirohashi N. 5, Tanigawa K. 5, Ito Y. 2, Kimura H. 6, Kataoka T. 3 1 Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan, 2 Division of Rehabilitation, Department of Clinical Support, Hiroshima University Hospital, 3 Institute of Biomedical and Health Sciences, Hiroshima University, 4 Department of Nursing, Hiroshima University Hospital, 5 Department of Emergency and Critical Care Medicine, Institute of Biomedical Sciences, Hiroshima University, 6 Department of Rehabilitation, Hiroshima University Hospital 【 PT program 】 ・ postural drainage ・ breathing exercise ・ range of motion exercise ・ activities of daily living exercise including sitting, standing and walking ※ Physical therapists are stationed at the ICU and round with the physician and nurse each morning to discuss changes in patients’ status. 【 Contraindication 】 ・ Respiratory rate 40 for ≧ 5 min ・ SpO 2 < 88% for 5 min ・ Systolic Blood Pressure < 80mmHg for 5 min ・ Bed rest order ・ Evidence of a novel arrhythmia ・ Agitation ・ Active gastrointestinal bleeding ・ Actively undergoing a procedure This was a retrospective cohort study. 【 Date collection 】 ・ Demographics ・ Body mass index ・ ICU admission diagnosis ・ Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score ・ Charlson comorbidity index ・ Days from ICU admission to initiating PT ・ Days from admission until the patient could get out of bed ・ The length of stay in the ICU ・ Mechanical ventilation support days April 2011 to March 2012 April 2012 to March 2014 days Recommendations It is important that paramedical staff actively take part in the decision making on the initiation of physical therapy for patients with critical illnesses. days † ＊ ＊ : p=0.000 †: p=0.002 Physician