Early Mobilization of Mechanically Ventilated Patients: A 1-Day Point-Prevalence Study in Germany*
Early Mobilization of Mechanically Ventilated Patients: A 1-Day Point-Prevalence Study in Germany*
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DOI：
10.1097/ccm.0000000000000149
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发表时间：
2014-05-01
影响因子：
8.8
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
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作者：
Nydahl, Peter;Ruhl, A. Parker;Needham, Dale M.
目的：越来越多的证据支持 ICU 中成年机械通气患者的早期活动。然而，对于常规 ICU 实践中的早期活动知之甚少。因此，跨学科的德国 ICU 早期活动网络在德国各地进行了为期 1 天的点患病率调查。设计：一日点患病率研究。设置：2011 年德国有 116 个 ICU。患者：所有成人机械通气患者。干预措施：无。测量和主要结果：在 24 小时内，提取了医院和 ICU 特征、患者活动水平以及相关的数据。动员过程中发生的障碍和并发症。 116 个参与的 ICU 提供了 783 名患者的数据。总体而言，185 名患者 (24%) 被从床上活动起来（即坐在床边或更高程度的活动）。在接受气管插管、气管切开术和无创通气的患者中，分别有 8%、39% 和 53% 下床活动（三组之间的差异 p < 0.001）。让患者下床活动最常见的障碍是心血管不稳定（17%）和深度镇静（15%）。下床活动与留在床上相比，与较高的并发症发生率无关，下床活动的患者没有发生跌倒或拔管。结论：在这项在德国各地进行的为期 1 天的点患病率研究中，只有 24% 的所有机械通气患者和 8% 的气管插管患者作为常规护理的一部分被下床活动。解决可改变的动员障碍（例如深度镇静）对于提高德国重症监护病房的动员程度非常重要。
Objectives:There is growing evidence to support early mobilization of adult mechanically ventilated patients in ICUs. However, there is little knowledge regarding early mobilization in routine ICU practice. Hence, the interdisciplinary German ICU Network for Early Mobilization undertook a 1-day point-prevalence survey across Germany.Design:One-day point-prevalence study.Setting:One hundred sixteen ICUs in Germany in 2011.Patients:All adult mechanically ventilated patients.Interventions:None.Measurements and Main Results:For a 24-hour period, data were abstracted on hospital and ICU characteristics, the level of patient mobilization and associated barriers, and complications occurring during mobilization. One hundred sixteen participating ICUs provided data for 783 patients. Overall, 185 patients (24%) were mobilized out of bed (i.e., sitting on the edge of the bed or higher level of mobilization). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 8%, 39%, and 53% were mobilized out of bed, respectively (p < 0.001 for difference between three groups). The most common perceived barriers to mobilizing patients out of bed were cardiovascular instability (17%) and deep sedation (15%). Mobilization out of bed versus remaining in bed was not associated with a higher frequency of complications, with no falls or extubations occurring in those mobilized out of bed.Conclusions:In this 1-day point-prevalence study conducted across Germany, only 24% of all mechanically ventilated patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of routine care. Addressing modifiable barriers for mobilization, such as deep sedation, will be important to increase mobilization in German ICUs.