S6 Abstracts / Australian Critical Care 32 (2019) S1eS18

Introduction: Bioelectrical impedance spectroscopy (BIS) is a modality to Conclusions: ICUAW incidence was comparable to 2014. However, the
analyse body composition (BC) and provides measurements of fluid and 2018 cohort was less unwell and had higher awakening MRC-ss. This could
nutrition status. The utility of BIS in identifying muscle weakness and potentially account for the higher percentage of participants’ discharged
functional limitations in critical illness is unknown. home and non-significant improvement in MRC-ss/PFIT-s scores observed,
Objectives: To describe BIS derived BC from three Australian ICU’s, and, despite increased physiotherapy interventions.
associations with muscle strength and physical function.
https://doi.org/10.1016/j.aucc.2018.11.022
Methods: A retrospective study of adults who required
48-hours of
mechanical ventilation. Data were extracted from prospective studies that
used: the SF-B7 BIS device/software with the manufacturer’s default re- Therapeutic Concentrations of Vancomycin are not Maintained in
sistivity constants for BC analysis (proportion (%) of total body water Critically Ill Patients Transitioning to Ward Therapy
(TBW), fat mass (FM), fat free mass (FFM)); medical research council sum-
score (MRC-SS) for muscle strength; and physical function in ICU test Kathryn Hunt 1
(PFIT-s) for physical function. Cross-sectional analyses with non-para-
1
metric statistics of pooled and individual site data included BIS at enrol- Flinders Medical Centre, Bedford Park, Australia
ment (48-hours of admission: site-A Melbourne, site-B Brisbane) and
awakening from sedation (site-A Melbourne, site-C, Adelaide). Introduction: There is increasing evidence to support the use of vanco-
Results: 143 participants (site-A n ¼ 60, site-B n ¼ 50, site-C n ¼ 33,) were mycin via continuous infusion in critically ill patients. To facilitate transfer
aged 62[50e69] years (median [1ste3rd quartile]). At enrolment TBW%, FM between continuous infusion and intermittent therapy, a local protocol
% and FFM% did not differ between site-A and site-B (p>0.05). Using pooled was developed and audited.
data, enrolment TBW%/FFM%/FM% were not associated with MRC-ss at Objectives: To identify the aspects of transfer of care that impact upon the
awakening, or, MRC-SS/PFIT-s at ICU discharge. However, FFM% at enrol- therapeutic transfer of patients receiving continuous vancomycin and
ment was associated with MRC-SS/PFIT-s at ICU discharge within site-B identify potential areas for improvement.
(rho ¼ 0.333, p ¼ 0.047). At awakening there was less TBW%, less FFM%, Methods: This study was conducted in an adult tertiary intensive care
and greater FM% at site-C versus site-A (p  0.038). Using pooled data, unit. Data was collected prospectively and retrospectively across a
awakening TBW%/FFM%/FM% were not associated with MRC-SS at awak- 15-month period and included all patients transferred to the ward on
ening or MRC-SS/PFIT-s at ICU discharge. However, within site-C greater intravenous vancomycin therapy. Audit criteria for ideal ward transfer was
TBW%, greater FFM% and less FM% were associated with MRC-SS at defined as:
awakening and PFIT-s at hospital discharge (rho
0.457, p  0.049).
Conclusion(s): Minor protocol and cohort differences may have influenced 1. First intermittent dose given immediately following cessation
site variations. Individual site data suggests that BIS may have a role in of continuous infusion
non-volitional screening of weakness and poor function, warranting 2. Dosage conversion consistent with the hospital protocol
further investigation.
3. Collection of the first serum trough vancomycin concentration
https://doi.org/10.1016/j.aucc.2018.11.021 sample within 48 hours of ward transfer
4. Initial ward trough serum vancomycin concentration of
An Exploration of Physiotherapy Service Provision to Patients' with 15-20mg/L.
Intensive Care Unit (ICU) Acquired Weakness: An Observational Study
Results: Thirty-one patients with complete data were assessed. Only
Lisa Beach 1, Daniel Jenkins 1, Catherine Granger 1, 2 six of the 31 (19%) patients received an immediate dose of vancomycin
on cessation of their infusion, with dosage converted appropriately in
1
Melbourne Health, Parkville, Australia 16 patients (52%). The majority of patients (25/31, 81%) had their first
2
The University of Melbourne, Carlton, Australia vancomycin level taken within 48 hours of transfer. Trough levels
were taken in all but five patients (83%) with 17 initial levels (55%)
Introduction: As ICU survival improves, the sequelae of critical illness are assessed as therapeutic. Considering the four points for ideal transfer,
increasingly recognised; including ICU acquired weakness (ICUAW). no cases met all four criteria, three criteria in 11 cases, two criteria in
However little is known about standard physiotherapy provision to this 15 cases, one criterion in three cases, and none of the criteria in five
group. cases.
Objectives: Determine the incidence of ICUAW. Describe physiotherapy Conclusion(s): These results indicate significant room for improvement in
treatment to patients’ with ICUAW in ICU and on the acute wards. Identify the therapeutic transfer of patients receiving continuous vancomycin
differences in care provision and patient outcomes compared with therapy.
observational data from 2014.
Methods: Prospective, single centre observational study conducted in a https://doi.org/10.1016/j.aucc.2018.11.023
tertiary ICU from 27/1/2018 to 31/5/2018. Patients’ who were mechanically
ventilated for >48hours and expected to stay in ICU another >24hours Multidisciplinary Staff Satisfaction with the ICU Physiotherapy Service
were screened for ICUAW using the Medical Research Council sum-score
(MRC-ss). Outcomes included: muscle strength (MRC-ss), physical function Lisa Beach 1, Janne Sheehan 1, Laura Knight 1, Catherine Granger 1, 2
(physical function in intensive care test-scored (PFIT-s)), number/type of
1
physiotherapy interventions. Comparisons were made with 2014 data. Melbourne Health, Parkville, Australia
2
Results: Incidence of ICUAW: 22% (n ¼ 11) compared with 25% in 2014 (n ¼ The University of Melbourne, Carlton, Australia
22). Participants were 55% male, mean(SD) age 61.9(12.0), ICU length of stay
(LOS) 15.5(8.3), median[IQR] hospital LOS 24.0[16.0e49.0] and APACHE II Introduction: Our ICU expanded from 24 to 32 beds in 2016. The phys-
15.0[12e25] 2018 and 26.0[21.0e28.2] 2014. Their mean(SD) MRC-ss and iotherapy team servicing ICU expanded from 1.84 EFT to 6.4 EFT (week-
PFIT-s scores were 39.0(6.4), 3.3(1.4) (2018) at awakening and 44.3(6.4), days) and 0.4 to 1.2 EFT (weekends) and added an evening service
4.1(1.2) at ICU discharge. MRC-ss (awakening) median[IQR] (2014) was 33.3 (weekdays).
[22.7 e 42.5]. No significant changes in MRC-ss/PFIT-s were observed be- Objectives: 1) Determine multidisciplinary staff satisfaction with the
tween awakening and ICU discharge (2018). Participants received a previous physiotherapy service (2016) and the current physiotherapy
mean(SD) physiotherapy sessions/awake day (ICU) 2.0(1.5) (2018), median service (2018), 2) Identify areas for improvement in physiotherapy service
[IQR] 0.9[0.6-1.0] (2014) and median[IQR] 0.6[0.3-1.0] on the ward (2018). provision.
Most common interventions were sitting on the edge of bed (35%) and Methods: A staff survey was developed, piloted and administered. 14
hoisting out of bed) 34% (ICU), walking (24%) and standing (22%) (wards). questions on a 5-point Likert scale assessing staff satisfaction with the
46% (2018), 9% (2014) of participants were discharged directly home. physiotherapy service were included. The survey was administered to ICU