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PURPOSE Physical impairment after critical illness is recognized as a part of the post-intensive care syndrome (PICS). About one third of intensive care unit (ICU) survivors suffer from long-term physical disability, yet the underlying pathophysiological mechanisms remain poorly understood. The pro-inflammatory alarmin, high mobility group box 1 (HMGB1), promotes muscle dysfunction in experimental models, and HMGB1 stays elevated in some patients after ICU discharge. Accordingly, we investigated the relationship between HMGB1 plasma levels and physical performance in ICU survivors. METHODS Prospective cohort study of 100 ICU survivors from the general ICU at the Karolinska University Hospital, Sweden. Patients returned for follow up at 3 (58 patients) and 6 months (51 patients) after ICU discharge. Blood samples were collected, and a 6-minute walk test (6-MWT), a handgrip-strength test (HST), and a timed-stands test (TST) were performed. RESULTS Compared to reference values of the different physical tests, 16% of patients underperformed at all tests at 3 months and 12% at 6 months. All test results, except hand-grip strength left, improved significantly over the follow-up period (P

Objective Early mobilization is advocated for patients going through abdominal surgery; however, little is known about the patient experience of being mobilized immediately after surgery. The purpose of this study was to explore patient experiences of mobilization immediately after elective abdominal cancer surgery. Methods This interview study used qualitative content analysis. With the use of purposeful sampling, a total of 23 participants who had been mobilized immediately after abdominal surgery were recruited at a university hospital in Stockholm, Sweden. Individual face-to-face interviews were conducted within 1 to 4 days after surgery and took place at the surgical ward where the participants were treated. A semi-structured guide was used. All interviews were audio recorded and transcribed verbatim. Results The content analysis revealed 3 categories that emerged into 1 overarching theme: “to do whatever it takes to get home earlier.” The participants experienced that mobilization out of bed had an impact on their physical and mental well-being. Motivation and the experiences of themselves and others were factors that affected patient attitudes toward early mobilization. Preparation and competent caregivers were emphasized as important factors that enabled the patient to feel safe and confident during mobilization. Conclusions Patients experienced mobilization as an important part of the care that had an impact on recovery and well-being, physically as well as mentally, both immediately and over time. Impact As this is the first study to our knowledge to investigate patient experiences of mobilization immediately after abdominal surgery, this information can be used to support the development of early mobilization protocols in hospital settings.

Objective The aim of this study was to investigate if mobilization out of bed, within 2 hours after abdominal surgery, improved participants’ respiratory function and whether breathing exercises had an additional positive effect. Methods Participants were 214 consecutively recruited patients who underwent elective open or robot-assisted laparoscopic gynecological, urological, or endocrinological abdominal surgery with an anesthetic duration of >2 hours. They were recruited to a randomized controlled trial. Immediately after surgery, patients were randomly assigned to 1 of 3 groups: mobilization (to sit in a chair) and standardized breathing exercises (n = 73), mobilization (to sit in a chair) only (n = 76), or control (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit and continued for a maximum of 6 hours. The primary outcomes were differences in peripheral oxygen saturation (SpO2, as a percentage) and arterial oxygen pressure (PaO2, measured in kilopascals) between the groups. Secondary outcomes were arterial carbon dioxide pressure, spirometry, respiratory insufficiency, pneumonia, and length of stay. Results Based on intention-to-treat analysis (n = 214), patients who received mobilization and breathing exercises had significantly improved SpO2 (mean difference [MD] = 2.5%; 95% CI = 0.4 to 4.6) and PaO2 (MD = 1.40 kPa; 95% CI = 0.64 to 2.17) compared with the controls. For mobilization only, there was an increase in PaO2 (MD = 0.97 kPa; 95% CI = 0.20 to 1.74) compared with the controls. In the per-protocol analysis (n = 201), there were significant improvements in SpO2 and PaO2 for both groups receiving mobilization compared with the controls. Secondary outcome measures did not differ between groups. Conclusion Mobilization out of bed, with or without breathing exercises, within 2 hours after elective abdominal surgery improved SpO2 and PaO2. Impact The respiratory effect of mobilization (out of bed) immediately after surgery has not been thoroughly evaluated in the literature. This study shows that mobilization out of bed following elective abdominal surgery can improve SpO2 and PaO2. Lay Summary Mobilization within 2 hours after elective abdominal surgery, with or without breathing exercises, can improve patients’ respiratory function.

Introduction: Early mobilization (EM), is highly recommended after abdominal surgery. Caregivers play an important role in motivating patients, facilitating the mobilization, assisting and guiding EM. Since the caregivers’ engagement seems to be crucial for successful mobilization, it is important to explore their experience in initiating and participating in mobilization immediately after surgery. Aim: to explore the caregivers experiences of mobilizing patients within the first hours after abdominal surgery. Material and Methods: Face-to-face interviews, following a semi-structured guide were conducted with 17 caregivers who participated in an RCT where patients were mobilized at a postoperative recovery unit, within the first two hours after abdominal cancer surgery. The transcribed interviews were analyzed in an inductive manner using qualitative content analysis. Results: The preliminary results indicate that the caregivers consider mobilization as an important part of the care at the postoperative recovery unit. Negative attitudes was based on that the caregivers did not have enough time or knowledge to perform EM. Positive attitudes was based on that the caregivers experienced that the patients tends to favor physically as well as mentally by EM. However, to facilitate EM at the postoperative recovery unit, there is a need for; education and predefined protocols for EM and that the intervention is supported by the management. Finally, there is a need for physiotherapists available when the patients´ enter the postoperative recovery unit, to guide and lead the EM. Conclusion: Knowledge about how caregivers experience EM immediately after surgery can facilitate safe and efficient mobilization.

Introduction: Early mobilization often in combination with breathing exercises is highly recommended after abdominal surgery. However, the isolated effect of early mobilization on respiratory function is still not evaluated. The overall aim was to evaluate the effects of immediate mobilization, within 2h (hours) after surgery on respiratory function in patients undergoing elective abdominal surgery. Material and methods: A total of 201 adult patients who underwent elective abdominal surgery, where the anesthetic time exceeded 2h, were randomized to: Mobilization - to sit in a chair + breathing exercises with PEP (n=68) Mobilization - to sit in a chair (n=69) Control - bedrest with maximum 30 degrees elevation (n=64) The interventions started within 2h of ended surgery and continued for a maximum of 6h. PaO2, SpO2 (primary outcomes) and PaCO2 were assessed every hour while breathing air. Information about pneumonia was retrieved from the patient´s medical record. Results: The premliminary analysis per protocol indicates that PaO2 as well as SpO2 increased over time (p Conclusion: Mobilization alone, or in combination with breathing exercises, within 2h after surgery, seems to improve PaO2 and SpO2 for patients who undergo elective abdominal surgery and to reduce the prevalence of pneumonia.

Objectives: To translate and culturally adapt the Chelsea Critical Care Physical Assessment Tool into Swedish and to test the inter-rater reliability of the Swedish version in critically ill patients. Design: This is an observational study. Methods: Translation and cross-cultural adaptation was performed in line with international recommendations, including forward and backward translation and expert round table discussions. The inter-rater reliability of the Chelsea Critical Care Physical Assessment Tool – Swedish was then explored in 50 critically ill adult patients, pragmatically recruited, in a University Hospital clinical setting. Reliability was calculated using intraclass correlation coefficient for aggregated scores and quadratic weighted Cohen’s kappa analysis for individual items Results: The expert round table discussion group agreed that the translation was a satisfactory equivalent to the original version and applicable for use within the clinical setting. Reliability of aggregated scores and individual items were very good (intraclass correlation coefficient of 0.97 and quadric weighted kappa values ranging from 0.88 to 0.98). The measurement error for aggregated scores was low, with a standard error of measurement of 1.79, smallest detectable change of 4.95, and limits of agreement of 5.20 and −4.76. The percentage agreement for individual items ranged from 64% to 88%. Conclusion: The Chelsea Critical Care Physical Assessment Tool – Swedish was found applicable and appropriate for assessment of functioning in critically ill patients in an acute setting in Sweden, and it displayed high inter-rater reliability. This implies that the Swedish version can be used as assessment tool within intensive care and acute wards in Sweden.Implications for rehabilitationThere is a lack of validated instruments to test the functional status of critically ill patients in Sweden.The Chelsea Critical Care Physical Assessment Tool is validated and reliable in English.The Chelsea Critical Care Physical Assessment Tool – Swedish is considered reliable for use by physiotherapist in intensive care settings in Sweden.The Swedish version is feasible for use within clinical practice due to its simplicity and strong clinical relevance. There is a lack of validated instruments to test the functional status of critically ill patients in Sweden. The Chelsea Critical Care Physical Assessment Tool is validated and reliable in English. The Chelsea Critical Care Physical Assessment Tool – Swedish is considered reliable for use by physiotherapist in intensive care settings in Sweden. The Swedish version is feasible for use within clinical practice due to its simplicity and strong clinical relevance.

Summary Objectives To describe a multidisciplinary intensive care follow-up and the methods used for identifying and managing physical and psychological problems in ICU survivors. Methods Patients treated > four days in an intensive care unit (ICU) were invited three, six and 12 months after intensive care for screening of physical problems with function tests and psychological problems with the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). Results 40 of 61 patients had clinically impaired physical function, with no ongoing physical rehabilitation at three months. Twenty-two patients received specific training instructions and 18 patients were referred for physiotherapy. 34 of 61 patients had symptoms of moderate to severe posttraumatic stress and/or symptoms of clinically significant anxiety or depression. Twelve patients accepted referral for psychiatric evaluation and treatment. Conclusion Multidisciplinary follow-up after intensive care can be of value in identifying untreated physical and psychological problems in ICU survivors. Liaison with specialists enables referral for identified problems. Patients screened and treated in the first six months appear to have little need for further follow-up after intensive care.