Assessment and identification of predictors of performance of early rehabilitation of patients in the general intensive care unit.

Abstract

Introduction. Currently, there are no universal criteria for assessing the volume of predicted functional recovery of patients during rehabilitation in intensive care units. Objective. To identify independent predictors of efficiency of rehabilitation of patients after a critical illness. Materials and methods. The study was conducted on the basis of a general ICU in 2017-2019. Patients with a short course of rehabilitation (< 7 days), deep impairment of consciousness (< 7 points on the Glasgow coma scale), decompensated multiple organ failure were excluded from the study. Clinical and laboratory data of 82 patients were retrospectively analyzed, including baseline severity of the condition, degree of functional independence and mobility, assessment of neurological deficit, incidence of depression and delirium, duration of mechanical ventilation and terms of hospitalization. We used a calculated indicator to analyze the effectiveness of rehabilitation - the rehabilitation potential index (RPI). Patients were assigned to the group of effective rehabilitation (ER) or ineffective rehabilitation (IR) depending on the level of RPI. Results. The duration of mechanical ventilation, the frequency of impaired consciousness and the duration of hospitalization were higher in the IR group than in the ER group. Consciousness impairment was found to be an independent predictor of low efficacy of the rehabilitation (odds ratio 4.53; confidence interval 95 % 1.63-12.6; p < 0.05). Conclusions. RPI can be used as a tool for assessing the effectiveness of rehabilitation of patients after a critical illness. The duration of mechanical ventilation has a negative effect on the functional outcome at discharge from the intensive care unit. The initial level of consciousness can be a benchmark for predicting the effectiveness of rehabilitation. Further prospective studies are needed to identify predictors of the effectiveness of early rehabilitation.