Early mobilisation and rehabilitation in Swiss intensive care units: a cross-sectional survey

BACKGROUND: Patients in intensive care units (ICUs) are at high risk of developing physical, functional, cognitive, and mental impairments. Early mobilisation aims to improve patient outcomes and is increasingly considered the standard of care. This survey aimed to investigate the characteristics, current use and variations of early mobilisation and rehabilitation in Swiss ICUs. METHODS: We conducted a cross-sectional survey among all ICU lead physicians, who provided data on their institutional characteristics, early mobilisation and rehabilitation practices, and their perceptions of the use and variation of early rehabilitation practices in Switzerland. RESULTS: The survey response rate was 44% (37/84). Among ICUs caring for adults (34/37), 26 were in the German-speaking region, five in the French-speaking region, and three in the Italian-speaking region. All ICUs regularly involved physiotherapy in the rehabilitation process and 50% reported having a specialised physiotherapy team. All ICUs reported performing early mobilisation, starting within the first 7 days after ICU admission. About half reported the use of a rehabilitation (45%) or early mobilisation protocol (50%). Regular, structured, interdisciplinary rounds or meetings of the ICU care team to discuss rehabilitation measures and goals for patients were stated to be held by 53%. The respondents stated that 82% of their patients received early mobilisation measures during their ICU stay. Most frequently provided mobilisation measures included passive range of motion (97%), passive chair position in bed (97%), active range of motion muscle activation and training (88%), active side to side turning (91%), sitting on the edge of the bed (94%), transfer from bed to a chair (97%), and ambulation (94%). The proportion of ICUs providing a specific early mobilisation measure, the proportion of patients receiving it, and the time dedicated to it varied across language regions, hospital types, ICU types, and ICU sizes. Almost one third of the ICU lead physicians considered early rehabilitation to be underused in their own ICU and about half considered it to be underused in Switzerland more generally. ICU lead physicians stressed lack of personnel, financial resources, and time as key causes for underuse. Moreover, they highlighted the importance of early and systematic or protocol-based rehabilitation and interprofessional approaches that are adaptive to the patients' rehabilitation needs and potential. CONCLUSION: This survey suggests that almost all ICUs in Switzerland practice some form of early mobilisation with the aim of early rehabilitation. However, the described approaches, as well as the reported use of early mobilisation measures were heterogenous across Swiss ICUs

[Including family in nursing care of patients with delirium on intensive care units]

Angehörige von Patient(inn)en auf Intensivstationen befinden sich in einer belastenden Situation – gleichzeitig sind sie wichtig für Pflegende und Patient(inn)en, etwa bei der Prävention und Behandlung eines akuten Delirs. Für die Erarbeitung eines Konzeptes zur Nutzung der Angehörigenressourcen wurde eine systematische Literaturübersicht durchgeführt zur Fragestellung: Mit welchen Maßnahmen können Angehörige von erwachsenen Intensivpflegepatient(inn)en mit Delir in ihrer unterstützenden Rolle gefördert werden? Acht qualitative und zwei quantitative Studien konnten als relevant identifiziert werden. Durch den Einbezug in die Pflege gewinnen Angehörige Sicherheit und erweitern ihr Verständnis für die Situation. Informationen und Anleitung haben höhere Priorität als emotionale Unterstützung durch Pflegende. Patient(inn)en mit Delir können mithilfe ihrer Angehörigen einfacher kommunizieren und fühlen sich sicherer. Pflegende erhalten Informationen und können die Zusammenarbeit individuell gestalten, wobei zeitliche und personelle Engpässe als problematisch beschrieben werden. Die professionelle Unterstützung von Angehörigen durch Pflegende liegt in der Befriedigung ihrer Bedürfnisse sowie in der Anleitung bei pflegerischen Maßnahmen. Pflegende benötigen ebenfalls Unterstützung in der Begleitung der Angehörigen. Strukturelle Vorgaben sowie prozess- und handlungsbezogene Anweisungen helfen den Pflegenden, die Angehörigen systematisch einzubeziehen. Dies kann unterstützend sein in der Gewährleistung der Patient(inn)ensicherheit sowie bei der Prävention und Behandlung des Delirs

Development and validation of a multivariable risk score for prolonged length of stay in the surgical intensive care unit

BACKGROUND: Chronically critical illness is highly relevant in intensive care units, but the definitions in literature vary greatly. The timely detection of prolonged intensive care unit length of stay could support care planning for chronically critical ill patients.AIM: To develop and validate a risk score for predicting prolonged length of stay in the surgical intensive care unit.METHODS: This single centre cohort study formed part of a nursing-led project in one surgical intensive care unit. We examined the performance of seven predefined predictive factors of prolonged (>20 days) intensive care unit length of stay in adults on the seventh day of stay in intensive care to develop (n = 304) and validate (n = 101) a risk score. Candidate variables (Charlson Comorbidity Index, Simplified Acute Physiology Score II, minimum plasma albumin, need for anti-infective drugs, time of mechanical ventilation, main feeding method and score on the Sedation-Agitation Scale) were analysed using multiple logistical regression analysis.RESULTS: Our risk score assigned different points to the following conditions: Charlson Comorbidity Index >2, minimum albumin <20 g/l between days 1 and 7, mechanical ventilation >14 hr on day 7 and the need for parenteral nutrition on day 7. For a validation data set (n = 101), the area under the receiver operating characteristic curve was 0.89 (95% confidence interval 0.77­0.87). At a cut-off value of 100 points, the degree of sensitivity was 88%, the specificity 75%, the positive predictive value 53%, the negative predictive value 95%, and the model fit R2 0.40.CONCLUSIONS: Our model allowed the timely detection of prolonged intensive care unit length of stay with four candidate predictive factors. The timely identification of patients with prolonged intensive care unit length of stay is possible and could influence the person-centred prevention of chronically critical illness and adequate resource allocation. (Trial registration no DRKS 00017073)

Temporal trends of COVID-19 related in-hospital mortality and demographics in Switzerland – a retrospective single centre cohort study

AIMS The aim of this study was to analyse the demographics, risk factors and in-hospital mortality rates of patients admitted with coronavirus disease 2019 (COVID-19) to a tertiary care hospital in Switzerland. METHODS In this single-centre retrospective cohort study at the University Hospital Basel, we included all patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalised from 27 February 2020 to 10 May 2021. Patients’ characteristics were extracted from the electronic medical record system. The primary outcome of this study was temporal trends of COVID-19-related in-hospital mortality. Secondary outcomes were COVID-19-related mortality in patients hospitalised on the intensive care unit (ICU), admission to ICU, renal replacement therapy and length of hospital stay, as well as a descriptive analysis of risk factors for in-hospital mortality. RESULTS During the study period we included 943 hospitalisations of 930 patients. The median age was 65 years (interquartile range [IQR] 53–76) and 63% were men. The numbers of elderly patients, patients with multiple comorbidities and need for renal replacement therapy decreased from the first and second to the third wave. The median length of stay and need for ICU admission were similar in all waves. Throughout the study period 88 patients (9.3%) died during the hospital stay. Crude in-hospital mortality was similar over the course of the first two waves (9.5% and 10.2%, respectively), whereas it decreased in the third wave (5.4%). Overall mortality in patients without comorbidities was low at 1.6%, but it increased in patients with any comorbidity to 12.6%. Predictors of all-cause mortality over the whole period were age (adjusted odds ratio [aOR] per 10-year increase 1.81, 95% confidence interval [CI] 1.45–2.26; p <0.001), male sex (aOR 1.68, 95% CI 1.00–2.82; p = 0.048), immunocompromising condition (aOR 2.09, 95% CI 1.01–4.33; p = 0.048) and chronic kidney disease (aOR 2.25, 95% CI 1.35–3.76; p = 0.002). CONCLUSION In our study in-hospital mortality was 9.5%, 10.2% and 5.4% in the first, second and third waves, respectively. Age, immunocompromising condition, male sex and chronic kidney disease were factors associated with in-hospital mortality. Importantly, patients without any comorbidity had a very low in-hospital mortality regardless of age

Novel XX-band transverse deflection structure with variable polarization

A collaboration between DESY, PSI and CERN has developed and built an advanced modular $X$-band transverse deflection structure (TDS) system with the new feature of providing variable polarization of the deflecting force. The prototype of the novel $X$-band TDS, the polarizable $X$-band (PolariX) TDS, was fabricated at PSI following the high-precision tuning-free production process developed for the C-band Linac of the SwissFEL project. Bead-pull rf measurements were also performed at PSI to verify, inparticular, that the polarization of the dipole fields does not have any rotation along the structure. The high-power test was performed at CERN and now the TDS is at DESY and has been installed in theFLASHForward beamline, where the first streaking experience with beam has been accomplished. We summarize in this paper the rf design of the TDS and its key components, such as the $X$-band pulse compressor, E-rotator, and phase shifter, the results of the bead-pull measurements and the high power test and finally the rf setup at DESY

Beam-based commissioning of a novel X-band transverse deflection structure with variable polarization

Longitudinal electron-beam diagnostics play a critical role in the operation and control of x-ray free-electron lasers, which rely on parameters such as the current profile, the longitudinal phase space, or the slice emittance of the particle distribution. On the one hand, the femtosecond-scale electron bunches produced at these facilities impose stringent requirements on the resolution achievable with the diagnostics. On the other, research and development of novel accelerator technologies such as beam-driven plasma-wakefield accelerators (PWFA) demand unprecedented capabilities to resolve the centroid offsets in the full transverse plane along the longitudinal bunch coordinate. We present the beam-based commissioning of an advanced X-band transverse-deflection rf structure (TDS) system with the new feature of providing variable polarization of the deflecting force: the PolariX-TDS. By means of a comprehensive campaign of measurements conducted with the prototype, key parameters of the rf performance of the system are validated and a phase-space characterization of an electron bunch is accomplished with a time resolution of 3.3 fs. Furthermore, an analysis of second-order effects induced on the bunch from its passage through the PolariX-TDS is presented