Chest
Clinical InvestigationsINFECTIONEarly Mobilization of Patients Hospitalized With Community-Acquired Pneumonia
Section snippets
Protocol
The study population included patients with CAP admitted to three hospitals in St. Louis, MO from November 17, 1997, through April 30, 1998. Inclusion criteria were ≥ 18 years old, new infiltrate on chest radiograph (compared with old radiographs if available), and either one major criteria (cough, sputum production, or temperature > 37.8°C) or two minor criteria (pleuritic chest pain, dyspnea, altered mental status, pulmonary consolidation on examination, or leukocyte count > 12,000/μL).12,13
Patients
Four hundred fifty-eight of 711 patients (64%) hospitalized with CAP were included in the study. Patient exclusions were hospitalization within 2 weeks of the current hospital admission (n = 190), diagnosis with large-volume aspiration pneumonia (n = 31), admission or transfer to an ICU (n = 17), or assignment to a nonstudy hospital unit (n = 15). Of the 458 patients enrolled, 428 patients (93%) met the major criteria and 30 patients (7%) met the minor criteria for definitive or presumptive
Discussion
Our data suggest that EM of patients with CAP with movement out of bed for at least 20 min during the first 24 h of hospitalization and progressive daily mobilization can reduce hospital length of stay without increasing risk of adverse outcomes. Although this intervention has been shown to be effective for other disease entities,10,11 EM is not recommended in CAP care nor is it a therapeutic component of current CAP guideline recommendations.20,21 We did not observe a dose-response
ACKNOWLEDGMENT
We thank the patients, families, nurses, and administrators at Barnes-Jewish Hospital, Christian Hospital Northeast and Missouri Baptist Medical Center for their participation and support. We thank Vicki Ferris, Neice Green, Naomi Hampton, JoAnn Johnson, Krista Kuhn, Barb Quick, Cindy Spies and Lynn Williams for data collection; Debbie Geiselman, Judy Musick, and Connie Sinn for data management; Jennie Dulac for administrative support; and Jordana Stewart for manuscript preparation.
References (23)
- Centers for Disease Control and Prevention. Premature deaths, monthly mortality and monthly physician contacts-United...
Medicare and Medicaid statistical supplement, 1997 [abstract]
Health Care Finance Rev
(1997)- et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia
N Engl J Med
(1997) - et al.
The clinical benefit of in-hospital observation of “low risk” pneumonia patients after conversion to oral antimicrobial therapy
Chest
(1998) - et al.
Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia
Arch Intern Med
(1995) Switch therapy in community-acquired pneumonia
Diag Microbiol Infect Dis
(1995)- et al.
Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia
Arch Intern Med
(1999) - et al.
Practice guidelines for the management of community-acquired pneumonia in adults
Clin Infect Dis
(2000) - et al.
Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy
Am Rev Respir Dis
(1993) Early ambulation after myocardial infarction: the in-patient exercise program
Clin Sports Med
(1984)
Early inpatient rehabilitation after elective hip and knee arthroplasty
JAMA
Cited by (170)
Management of Non-Ventilated hospital acquired pneumonia
2024, Clinical Infection in PracticeEffects of Unstructured Mobility Programs in Older Hospitalized General Medicine Patients: A Systematic Review and Meta-Analysis
2021, Journal of the American Medical Directors AssociationCitation Excerpt :In addition, Cohen and colleagues19 reported a significant reduction in ADL decline 1 month postdischarge in the mobility group; however, there was no difference between groups for IADL at the 1-month follow-up. Nine of the 13 studies assessed the effect of mobility programs compared with usual care on LOS in general medicine units.13–15,20,22,23,25–27 A random effects meta-analysis of 2 RCTs including 526 participants showed no evidence of an overall effect of unstructured mobility interventions on LOS (mean difference –0.36, 95% CI –1.92 to 1.21) and substantial heterogeneity (I2 = 68%) (Figure 3).25,26
Reply to «Rational use of antimicrobials in home hospitalization«
2021, Enfermedades Infecciosas y Microbiologia ClinicaCommunity-Acquired Pneumonia
2021, Encyclopedia of Respiratory Medicine, Second EditionInterventions for reducing hospital-associated deconditioning: A systematic review and meta-analysis
2020, Archives of Gerontology and GeriatricsCitation Excerpt :No studies reported health-related quality of life as an outcome. Health utilisation costs were assessed by hospital length of stay (Lenze et al., 2012; Mundy et al., 2003; Timmer et al., 2019), hospital re-admission (Hastings et al., 2014; Landefeld et al., 1995; Mundy et al., 2003; Timmer et al., 2019), and nursing home placement (Counsell et al., 2000; Landefeld et al., 1995; Liu et al., 2018). There was moderate-quality evidence (downgraded by risk of bias) of no benefit of enhanced programmes of usual care for hospital length of stay (MD: −0.59; 95 % -1.64 to 0.46; N = 574).
Prevention practices for nonventilator hospital-Acquired pneumonia: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN)
2022, Infection Control and Hospital Epidemiology
This project was funded by the Innovations for Healthcare Program of the Center for Healthcare Quality and Effectiveness, BJC Health System, St. Louis, MO.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).