Exercise intervention in the critical care unit what is the evidence?
Exercise intervention in the critical care unit what is the evidence?
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DOI：
10.1179/174328809x405900
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发表时间：
2009-01-01
影响因子：
0.7
通讯作者：
Thomas, Amanda
中科院分区：
文献类型：
--
作者：
Thomas, Amanda
目的：身体疾病是一种有据可查的现象，患者因危重病卧床，并可能在重症监护住院后持续数月。在重症监护住院期间开始的早期康复活动可能会改善这些变化，并减少与重症监护入院相关的长期护理负担。本综述的目的是探讨危重病患者康复问题的已知证据。方法：通过数据库检索，检索关键词：动员、康复、运动疗法、物理疗法、截肢、肌力、功能训练、机械通气、重症监护和重症监护。结果：物理治疗实践在欧洲，北美和澳大拉西亚各地差异很大，重症患者的康复干预措施很少受到研究关注。检索到的数据按以下类别进行审查：a）重症监护室内康复实践的发生率，B）与危重患者锻炼相关的安全问题，c）危重患者对锻炼的急性反应，以及d）呼吸机依赖受试者中体育训练计划的影响。讨论：在重症监护环境中进行体能训练的有效性证据仍然局限于长期呼吸衰竭患者，这些患者可能不代表一般重症人群。在内科患者机械通气开始后48小时内开始的方案启动的物理治疗干预的初步数据显示，重症监护室和住院时间均缩短。很明显，应该拨出研究经费来加强这一领域的物理学实践。特别是肌肉力量、功能量表和其他结局指标（包括脱离机械通气的天数和住院时间）之间的关系需要探讨。
Objectives: Physical morbidity is a well documented phenomenon of the patient confined to bed with critical illness and may persist for months following the critical care stay. Early rehabilitation activities initiated during the critical care stay may ameliorate these changes and reduce the long term burden of care associated with a critical care admission. The objective of this review is to explore the known evidence examining the issue of rehabilitation of the patient with critical illness.Methods: Database searches were performed to retrieve the search terms mobilisation, rehabilitation, exercise therapy, physiotherapy, ambulation, muscle strength, functional training, mechanical ventilation, intensive care, and critical care.Results: Physiotherapy practice varies widely throughout Europe, North America and Australasia and rehabilitation interventions for critically ill patients have received little research attention. Retrieved data was reviewed in the following categories: a) The incidence of rehabilitation practices within intensive care units, b) Safety issues associated with exercising the critically ill patient, c) The acute response to exercise in the critically ill, and d) The effects of physical training programmes in ventilator dependent subjects.Discussion: Evidence of the effectiveness of physical training within the intensive care environment remains limited to long term respiratory failure patients who may not be representative of a general critically ill population. Preliminary data from protocol initiated physiotherapy intervention initiated within 48 h of the onset of mechanical ventilation in medical patients reveal both decreased intensive care unit and hospital length of stay. It is clear that research funding should be allocated to strengthen physiotherapeutic practice in this area. In particular the relationship between muscle strength, functional scales and other measures of outcome including number of days to wean from mechanical ventilation and length of stay need to be explored.