Exploration of Investigating ICU Mobilisation With Vasoactive Drugs

Study Overview
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Brief Summary
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There is a need to know more about the safety of mobilizing intensive care unit (ICU) patients who are receiving vasoactive drugs that support the heart and blood pressure. But before this research can be done, several uncertainties need to be addressed. To answer these uncertainties, the investigators will ask ICU patients receiving vasoactive drugs to take part in a study in three main stages. Firstly ICU patients will be asked whether they would be happy to take part in a future research trial on the safety of mobilizing patients who are receiving vasoactive drugs. Secondly, data will be collected about the current mobilization on vasoactive drugs that occurs. Finally, the investigators will try to follow up these patients 60 days after they start the study, to carry out some questionnaires and a walking test with the patients. These tests may be used in future research to measure the effect of mobilizing patients on vasoactive drugs.

Detailed Description
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The current evidence is insufficient to accurately guide clinicians to know when it is safe to start mobilizing intensive care unit (ICU) patients receiving vasoactive drugs. Before a randomized controlled trial can be designed, several uncertainties need to be addressed. This includes clarifying what standard care is, what potential recruitment rates would be and what the most suitable primary outcome measure is. This study is an exploratory observational study which will aim to recruit up to 40 ICU patients receiving vasoactive drugs to further clarify standard care and to measure preliminary feasibility outcomes. Upon enrolment, patients and clinicians will be surveyed about the hypothetical acceptability of recruitment into a future randomized controlled trial. Then any routine mobilization that occurs whilst the patient is receiving vasoactive drugs will be analyzed, for example, to describe how clinicians assessed safety for mobilization. Finally, patient participants will be followed up at day 60 to assess the feasibility of measuring candidate primary outcome measures.

Official Title
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Investigating the Safety of Mobilising Intensive Care Unit Patients Receiving Vasoactive Drugs: An Exploratory Observational Study

Conditions
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Critical Illness

Intervention / Treatment
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* Other: Mobilization


Participation Criteria
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Eligibility Criteria
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Patient participants: Inclusion Criteria: Patients admitted to the ICU who are receiving vasoactive drugs. Age greater than or equal to 18 years old. Expected to remain admitted to the ICU for at least 24 hours post-enrolment. Exclusion Criteria: Any patient who is expected to die imminently, as per clinical opinion. Any patient where mobilization is contraindicated by the nature of their existing injuries. Where it is clear from the medical records that participants are prisoners or offenders on probation. Patients with neuromuscular disease or acute brain injury or spinal cord injury. If the patient and/or their consultee is unable to speak English. Clinicians participating in a survey on hypothetical randomization of patient participants: Inclusion criteria: Clinicians who work in the intensive care unit where a patient participant has been admitted. Exclusion criteria: None. Clinician participants in the survey on the feasibility of the ICU physical rehabilitation adverse event tool: Inclusion criteria: An ICU clinician at the research site. Has used the ICU physical rehabilitation adverse event tool as part of this research study. Exclusion criteria: None.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intensive care patients<br>Adult intensive care patients receiving vasoactive drugs | Other: Mobilization<br>* Physical rehabilitation<br>|
| Intensive care unit clinicians<br>Clinicians for participation in a survey on the hypothetical randomization of patient participants in a future randomized controlled trial. | |
| ICU rehabilitation clinicians<br>Clinicians for participation in a survey on the feasibility of an ICU physical rehabilitation adverse event tool. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hypothetical Recruitment Rate for a Future Randomised Controlled Trial. | The number of patient participants who would hypothetically accept being randomised into a future trial on the safety of mobilising patients receiving vasoactive drugs. | Baseline (approximately one day from enrolment) | 
| Number of Participants With Follow-up at 60 Days | Patient participant follow-up rate at 60 days. | 60 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Rating the 'Early Versus no Rehabilitation' Randomisation Scenario Was Acceptable | Survey measuring participant acceptance of hypothetical randomisation scenarios: scenario 1: early versus no rehabilitation | Baseline (approximately one day from enrolment) | 
| Number of Participants Rating the 'Early Rehabilitation Versus Standard Care' Randomization Scenario as Acceptable | Survey measuring participant acceptance of hypothetical randomization scenarios: scenario 2: early rehabilitation versus standard care | Baseline (approximately one day from enrolment) | 
| Number of Participants Rating the 'Protocolised Rehabilitation Versus Standard Care' Randomisation Scenario as Acceptable | Survey measuring participant acceptance of hypothetical randomization scenarios: scenario 3: protocolised rehabilitation versus standard care | Baseline (approximately one day from enrolment) | 
| Number of Participants Where Participant Pre-morbid Comorbidities Measurement Was Not Completed. | Quantity of missing data resulting from measurement of participant pre-morbid co-morbidities. | Baseline (approximately one day from enrolment) | 
| Number of Participants Where Participant Pre-morbid Frailty Measurements Were Not Completed. | Quantity of missing data resulting from measurement of participant pre-morbid frailty. | Baseline (approximately one day from enrolment) | 
| Number of Participants Where Participant Pre-morbid Physical Function Measurement Was Not Completed. | Quantity of missing data resulting from measurement of participant pre-morbid physical function. | Baseline (approximately one day from enrolment) | 
| Who Made the Final Decision Whether to Mobilize the Patient | Recorded whenever a physiotherapist reviews a patient participant for potential physical rehabilitation whilst they are receiving vasoactive drugs and the patient was mobilized. | Through duration of ICU stay (average of 7 days). | 
| The Reasons for the Decision When Patient Was Mobilized. | Recorded whenever a physiotherapist reviews a patient participant for potential physical rehabilitation whilst they are receiving vasoactive drugs and the patient was mobilized. Qualitative measure: reasons underwent content analysis, with the outcome being the themes summarizing the reasons. | Through duration of ICU stay (average of 7 days). | 
| Who Made the Final Decision Whether to Not Mobilize the Patient | Recorded whenever a physiotherapist reviews a patient for potential physical rehabilitation whilst they are receiving vasoactive drugs and the patient was not mobilized. | Through duration of intensive care stay (average 7 days) | 
| The Reasons for the Decision When the Patient Was Not Mobilized. | Recorded whenever a physiotherapist reviews a patient for potential physical rehabilitation whilst they are receiving vasoactive drugs and the patient was not mobilized. Qualitative variable: reasons underwent qualitative analysis, with the output of a list of themes summarizing the reasons. | Through duration of intensive care stay (average 7 days) | 
| The Reason Why a Mobilisation Treatment Was Stopped | Recorded if a mobilisation treatment on vasoactive drugs is routinely carried out. | Through duration of ICU stay (average of 7 days). | 
| Number of Serious Adverse Events | Number of serious adverse events | Through whole of study, an estimated 6 months | 
| Number of ICU Physical Rehabilitation Adverse Events | Recorded using ICU physical rehabilitation adverse event tool, both by treating clinician and by researcher case note review. | Through duration of ICU stay (average of 7 days). | 
| Time Taken to Complete an ICU Physical Rehabilitation Adverse Event Tool. | Adverse event tool is completed if a mobilisation treatment on vasoactive drugs is routinely carried out. | Through duration of ICU stay (average of 7 days). | 
| Loss of Information That Occurs When Completing ICU Physical Rehabilitation Adverse Event Tool. | Tool completed both by treating clinician and by researcher case note review. Number of mobilization treatment sessions on vasoactive drugs where adverse event tool is complete. | Through duration of ICU stay (average of 7 days). | 
| Feasibility and Usability of an ICU Physical Rehabilitation Adverse Event Tool Measured by Survey. | A survey measuring user opinion on whether an adverse event tool was for example understandable and an appropriate length using a scale with 'yes', 'no' or 'unsure' responses. Survey adapted from Hodgson, C., Needham, D., Haines, K., Bailey, M., Ward, A., Harrold, M., Young, P., Zanni, J., Buhr, H., Higgins, A., Presneill, J. & Berney, S. 2014. Feasibility and inter-rater reliability of the ICU mobility scale. Heart Lung, 43. | Through second half of the study, an estimated 3 months | 
| Time to First Mobilisation Treatment | Number of days to first rehabilitation treatment | Through duration of hospital stay (average of 22 days) | 
| Time to First Being Able to Sit Out of Bed. | Regardless of the assistance required. | Through duration of hospital stay (average of 22 days) | 
| Time to First Being Able to Stand. | Regardless of the assistance required. | Through duration of hospital stay (average of 22 days). | 
| Time to First Being Able to Walk. | Regardless of assistance required. | Through duration of hospital stay (average of 22 days). | 
| Intensive Care Unit Length of Stay. |  | From admission to ICU discharge (an average of 7 days) | 
| Hospital Length of Stay |  | From admission to hospital discharge (average of 22 days) | 
| Intensive Care Unit Mobility Scale Level at ICU Discharge. | Intensive care unit mobility scale records a patient's mobility level from 0 to 10, where 0 means no mobility and 10 means walking without assistance from people or a physical aid. | ICU discharge (an average of 7 days from ICU admission) | 
| Number of Patient Participants Where All Candidate Primary Outcomes Are Completed. | Candidate primary outcomes: mortality, health-related quality of life, disability, physical functioning questionnaire and walking test. | 60 days. | 
| The Number of Patient Participants Who Completed Each Individual Candidate Primary Outcome. | Candidate primary outcomes: mortality, health-related quality of life, disability, physical functioning questionnaire and walking test. | 60 days. | 
| Data to Inform a Future Sample Size for a Future Randomized Controlled Trial. | Measures of central tendency and variability of data for candidate outcome measures to inform a sample size for future randomised controlled trial, e.g. physical functioning measured by the physical function domain of the RAND 36-Item Health Survey 1.0 Questionnaire (RAND SF-36 v1), scores range from 0-100, where a higher score means better physical functioning. | 60 days. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Critical Illness, Physical rehabilitation