Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU

Critical Care

Research

Carol Hodgson¹  Marco Lorenz²  Nils Daum²  Nadine Langer²  Maximilian Lindholz²  Kilian Blobner³  Margaret Herridge⁴  Bernhard Ulm⁵  Kristina E. Fuest⁵  Stefan J. Schaller⁶  Manfred Blobner⁷ 

[1] Acute and Critical Care, Monash University, Melbourne, VIC, Australia;Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany;Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany;Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Orthopedics, Munich, Germany;Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON, Canada;Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany;Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany;Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany;Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany;Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany;

关键词: Early ambulation;    Critical care;    Critical illness;    Physical therapy modalities;    Patient discharge;   

DOI  :  10.1186/s13054-022-04291-8

 received in 2022-11-01, accepted in 2022-12-21,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundWhile early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU cohort can provide individualized mobilization recommendations that have a positive impact on the likelihood of being discharged home.MethodsThis study is an analysis of a prospective observational database of two interdisciplinary intensive care units in Munich, Germany. Dosage of mobilization is determined by sessions per day, mean duration, early mobilization as well as average and maximum level achieved. A k-means cluster analysis was conducted including collected parameters at ICU admission to generate clinically definable clusters.ResultsBetween April 2017 and May 2019, 948 patients were included. Four different clusters were identified, comprising “Young Trauma,” “Severely ill & Frail,” “Old non-frail” and “Middle-aged” patients. Early mobilization (< 72 h) was the most important factor to be discharged home in “Young Trauma” patients (ORadj 10.0 [2.8 to 44.0], p < 0.001). In the cluster of “Middle-aged” patients, the likelihood to be discharged home increased with each mobilization level, to a maximum 24-fold increased likelihood for ambulating (ORadj 24.0 [7.4 to 86.1], p < 0.001). The likelihood increased significantly when standing or ambulating was achieved in the older, non-frail cluster (ORadj 4.7 [1.2 to 23.2], p = 0.035 and ORadj 8.1 [1.8 to 45.8], p = 0.010).ConclusionsAn artificial intelligence-based learning approach was able to divide a heterogeneous critical care cohort into four clusters, which differed significantly in their clinical characteristics and in their mobilization parameters. Depending on the cluster, different mobilization strategies supported the likelihood of being discharged home enabling an individualized and resource-optimized mobilization approach.Trial Registration: Clinical Trials NCT03666286, retrospectively registered 04 September 2018.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2

Fig. 1

Fig. 28

41116_2022_35_Article_IEq506.gif