Motor Activity, Muscle Strength, Muscle Weakness
Conditions
Keywords
critical care, patient discharge, costs and cost analysis, length of stay, hospital mortality
Brief summary
In the surgical intensive care unit (SICU), goals of critical care are often discussed in long-term ventilated patients around the time of extubation. Muscle weakness predicts extubation failure but formal muscle strength assessment by the Medical Research Council scale is time-consuming and not part of the daily clinical exam. In this observational study, we hypothesize that COMA measurement, routinely used by the SICU nurses, is a reliable and valid predictor for patients' SICU outcomes. This prospective observational study is carried out within a consecutively enrolled cohort of adult patients who are extubated in two SICUs at Massachusetts General Hospital, Boston.
Interventions
PROCEDURECOMA Score Assessment
Sponsors
Massachusetts General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 112 Years
Healthy volunteers
No
Inclusion criteria
* Intubated and mechanically ventilated patients in 2 ICUs at Massachusetts General Hospital * adult patients
Exclusion criteria
* Tracheostomy without extubation attempt * Death without extubation attempt/terminal extubation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Adverse discharge disposition | Within one day after hospital discharge |
Secondary
| Measure | Time frame |
|---|---|
| 30-day hospital readmission | Within 30 days after discharge from the index hospital stay |
| ICU length of stay | Time frame within 24 hours after ICU admission and within 24 hours after ICU discharge |
| Hospital length of stay | Time frame within 24 hours after hospital admission and within 24 hours after hospital discharge |
| 30-day mortality | Within 30-days after extubation in the ICU or until the day of hospital discharge |
| Hospital costs | Between the day of hospital admission and the day of hospital discharge |
Other
| Measure | Time frame | Description |
|---|---|---|
| Validation: correlation between COMA and actual skeletal muscle index assessed by computer tomography | Within 72 hours after extubation | Skeletal muscle index is measured at the level of the 3rd lumbar vertebrae |
| Validation: Receiver operating curve (ROC) analysis - Acute Physiology and Chronic Health Evaluation II | At the day of admission to the ICU as well as within 72 hours after extubation | ROC curve of COMA compared to ROC curve of Acute Physiology and Chronic Health Evaluation (APACHE) II |
| Validation: Receiver operating curve (ROC) analysis - Charlson Comorbidity Index | At the day of admission to the ICU as well as within 72 hours after extubation | ROC curve of COMA compared to ROC curve of Charlson Comorbidity Index (CCI) |
| Validation: Receiver operating curve (ROC) analysis - Richmond Agitation and Sedation Score | Within 72 hours after extubation | ROC curve of COMA compared to ROC curve of Richmond Agitation and Sedation Score (RASS) |
| Validation: Receiver operating curve (ROC) analysis - Confusion Assessment Method ICU score | Within 72 hours after extubation | ROC curve of COMA compared to ROC curve of Confusion Assessment Method (CAM) ICU score |
| Validation: weighed kappa statistics | Within 72 hours after extubation | Inter-rater agreement with COMA score between A.M. and P.M. shift nurse |
Countries
United States
Outcome results
None listed