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Use of actigraphy to characterize inactivity and activity in patients in a medical ICU

Published:February 24, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.02.002

      Highlights

      • Medical ICU patients demonstrate profound inactivity, and are making no movements about 2/3 of the time.
      • Activity levels were lowest in patients who were non-ambulatory prior to ICU admission and in patients with the highest severity of illness.
      • Inactivity was more prevalent in patients receiving mechanical ventilation and in sicker patients.
      • Sedation status, age, or presence of restraints did not contribute to differences in activity level.

      Abstract

      Background

      In the intensive care unit (ICU), inactivity is common, contributing to ICU-acquired weakness and poor outcomes. Actigraphy may be useful for measuring activity in the ICU.

      Objectives

      To use actigraphy to characterize inactivity and activity in critically ill patients.

      Methods

      This prospective observational study involved 48-h wrist actigraphy in medical ICU (MICU) patients, with activity data captured across 30-s epochs. Inactivity (zero-activity epochs) and activity (levels of non-zero activity) were summarized across key patient (e.g., age) and clinical (e.g., mechanical ventilation status) variables, and compared using multivariable regression.

      Results

      Overall, 189,595 30-s epochs were collected in 34 MICU patients. Zero-activity (inactivity) comprised 122,865 (65%) of epochs; these epochs were 24% and 13% more prevalent, respectively, in patients receiving mechanical ventilation (versus none, p < 0.001) and in the highest (versus lowest) organ failure score tertile (p = 0.03). Ambulatory (versus non-ambulatory) patients exhibited more non-zero activity (35 more movements per epoch, p < 0.001), while those in the highest (versus lowest) organ failure score tertile exhibited less activity (22 fewer movements per epoch, p = 0.03). Significant inactivity/activity differences were not observed when evaluated based on age, sedation, or restraint status.

      Conclusions

      Actigraphy demonstrated that MICU patients are profoundly inactive, including those who are young, non-sedated and non-restrained. Hence, ICU-specific, non-patient-related factors may contribute to inactivity, an issue requiring further investigation.

      Keywords

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