Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?
Dose of Early Therapeutic Mobility: Does Frequency or Intensity Matter?
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DOI：
10.1177/1099800418780492
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发表时间：
2018-10-01
影响因子：
2.5
通讯作者：
Levine, Alan
中科院分区：
文献类型：
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作者：
Winkelman, Chris;Sattar, Abdus;Levine, Alan
目的：探讨护士主导的活动方案的可行性，并比较每日1次与2次早期治疗活动（ETM）以及低强度与中等强度ETM对危重成人血清炎症生物标志物和选择结果的影响。设计：随机介入研究，重复测量和盲法评估结果。环境：四个成人重症监护病房（icu）在两个学术医疗中心。研究对象：54例颅脑通气48小时（MV）患者。干预：患者在入组时通过密封信封随机化被分配到每天一次或两次的ETM。（床内与床外）ETM的强度根据协议患者评估进行。检测方法：采集ETM前后血清白细胞介素6、10、8、15和肿瘤坏死因子-；在分析中使用变化分数。评估手肌和握力、谵妄发作、MV持续时间和ICU住院时间（LOS）作为患者预后。主要结果：关于炎症生物标志物的假设没有基于置信区间的支持。每日两次干预与ICU LOS降低相关。中等强度（床外）ETM与更高的手部肌肉测试分数和握力以及减少谵妄的发生有关。结论：本研究的结果表明，一旦患者状态稳定，护士可以提供每天两次的活动干预，包括坐在床的边缘，而不会改变促炎血清生物标志物。
Objective: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults.Design: Randomized interventional study with repeated measures and blinded assessment of outcomes.Setting: Four adult intensive care units (ICUs) in two academic medical centers.Subjects: Fifty-four patients with > 48 hr of mechanical ventilation (MV).Intervention: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment.Measurements: Interleukins 6, 10, 8, 15, and tumor necrosis factor- were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes.Main Results: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium.Conclusion: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.