Interventions to Improve the Physical Function of ICU Survivors A Systematic Review
Interventions to Improve the Physical Function of ICU Survivors A Systematic Review
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DOI：
10.1378/chest.13-0779
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发表时间：
2013-11-01
期刊：
影响因子：
9.6
通讯作者：
Boustani, Malaz A.
中科院分区：
文献类型：
--
作者：
Calvo-Ayala, Enrique;Khan, Babar A.;Boustani, Malaz A.
背景：美国ICU入院人数不断增加。严重疾病后，身体功能（PF）可能会受损长达5年。我们对ICU幸存者中针对PF的干预措施的疗效进行了随机对照试验的系统评价。本研究的目的是确定有效的干预措施，改善长期PF在ICU survivors.Methods：MEDLINE，医学文摘数据库（EMBASE），累积索引护理和相关健康文献（CINAHL），物理治疗循证数据库（PEDro）之间的1990年和2012年进行了检索。两名审查独立评估研究的资格，严格评价纳入研究，并提取数据到标准化evidence tables.Results：14项研究符合纳入标准。干预措施包括运动/物理治疗（PT）、肠外营养、护士引导的随访、自发觉醒试验、机械通气期间无镇静和早期气管切开术。九项研究未能证明对ICU幸存者PF的有效性。然而，早期的体育锻炼和PT为基础的干预措施，长期PF有积极的影响。结论：唯一有效的干预措施，以改善长期PF在危重患者的运动/PT，它的好处可能会更大，如果开始得早。需要在这一领域开展进一步研究，比较不同的干预措施和时机。
Background: ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.Methods: MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.Results: Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.Conclusions: The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.