Date of Award

1-1-2021

Embargo Period

5-1-2022

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Sarah Miller

Second Advisor

Susan Newman

Third Advisor

Martina Mueller

Fourth Advisor

Heather Dunn

Abstract

Of the 2 million adults who require mechanical ventilation (MV) in intensive care units (ICUs) in the United States every year, up to 65% develop physical disability post-intensive care (PD PIC). PD PIC is characterized by muscle weakness, reduced mobility, activity impairments, and difficulty returning to pre-critical illness roles, all of which negatively influence quality of life and produce financial hardship due to loss of employment. While early mobilization (EM) in the ICU may reduce or prevent PD PIC, numerous environmental and patient-level facilitators and barriers influence its delivery. Additionally, it is unknown which subgroups of patients are at greatest risk for PD PIC or may benefit most from EM in the ICU. This dissertation is a compendium of three manuscripts, each utilizing the World Health Organization International Classification of Functioning, Disability, and Health to illustrate the complex relationship between critical illness, environmental and patient-level factors, and PD PIC. First, a two-part integrative review was conducted to synthesize the environmental and patient-level facilitators and barriers to EM in the ICU and the subsequent relationship between these contextual factors and PD PIC. The third manuscript describes two parts of an original research study: 1) a latent class analysis of a sample of medical ICU patients to identify comorbid subgroups of patients with acute respiratory failure who required MV and 2) an analysis of differences in PD PIC at hospital discharge among these subgroups. The information presented in this dissertation work creates a foundation for future study of PD PIC in comorbid subgroups to reduce disability and improve quality of life in survivors of critical illness.

Rights

All rights reserved. Copyright is held by the author.

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