Subjective Assessment of Motor Function by the Bedside Nurses in Mechanically Ventilated Surgical Intensive Care Unit Patients Predicts Tracheostomy
Issued Date
2023-02-01
Resource Type
ISSN
08850666
eISSN
15251489
Scopus ID
2-s2.0-85131892846
Pubmed ID
35695208
Journal Title
Journal of Intensive Care Medicine
Volume
38
Issue
2
Start Page
151
End Page
159
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Intensive Care Medicine Vol.38 No.2 (2023) , 151-159
Suggested Citation
Friedrich S., Teja B., Latronico N., Berger J., Muse S., Waak K., Fassbender P., Azimaraghi O., Eikermann M., Wongtangman K. Subjective Assessment of Motor Function by the Bedside Nurses in Mechanically Ventilated Surgical Intensive Care Unit Patients Predicts Tracheostomy. Journal of Intensive Care Medicine Vol.38 No.2 (2023) , 151-159. 159. doi:10.1177/08850666221107839 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85133
Title
Subjective Assessment of Motor Function by the Bedside Nurses in Mechanically Ventilated Surgical Intensive Care Unit Patients Predicts Tracheostomy
Other Contributor(s)
Abstract
Objective: In many institutions, intensive care unit (ICU) nurses assess their patients’ muscle function as part of their routine bedside examination. We tested the research hypothesis that this subjective examination of muscle function prior to extubation predicts tracheostomy requirement. Methods: Adult, mechanically ventilated patients admitted to 7 ICUs at Beth Israel Deaconess Medical Center (BIDMC) between 2008 and 2019 were included in this observational study. Assessment of motor function was performed every four hours by ICU nurses. Multivariable logistic regression analysis controlled for acute disease severity, delirium risk assessment through the confusion assessment method for the ICU (CAM-ICU), and pre-defined predictors of extubation failure was applied to examine the association of motor function and tracheostomy within 30 days after extubation. Results: Within 30 days after extubation, 891 of 9609 (9.3%) included patients required a tracheostomy. The inability to spontaneously move and hold extremities against gravity within 24 h prior to extubation was associated with significantly higher odds of 30-day tracheostomy (adjusted OR 1.56, 95% CI 1.27−1.91, p < 0.001, adjusted absolute risk difference (aARD) 2.8% (p < 0.001)). The effect was magnified among patients who were mechanically ventilated for >7 days (aARD 21.8%, 95% CI 12.4−31.2%, p-for-interaction = 0.015). Conclusions: ICU nurses’ subjective assessment of motor function is associated with 30-day tracheostomy risk, independent of known risk factors. Muscle function measurements by nursing staff in the ICU should be discussed during interprofessional rounds.