A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU
A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU
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DOI：
10.1097/ccm.0000000000001643
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发表时间：
2016-06-01
影响因子：
8.8
通讯作者：
Webb, Steven
中科院分区：
文献类型：
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作者：
Hodgson, Carol L.;Bailey, Michael;Webb, Steven
目的：确定早期目标导向的动员干预是否可以应用于接受机械通气的患者，与标准护理相比，最大活动水平增加。设计：先导性随机对照试验。设置：澳大利亚和新西兰的5个ICU。参与者：50名危重患者，机械通气超过24小时。干预：患者被随机分配到早期目标导向动员(干预)或标准护理(对照)。早期目标导向动员包括在接受机械通气的同时通过ICU活动度量表对患者进行尽可能高的活动水平的功能康复治疗。测量和主要结果：记录ICU活动度、强度、呼吸机持续时间、ICU和住院时间、住院(急性和康复)总住院日以及ICU出院后6个月与健康相关的生活质量、日常生活能力以及焦虑和抑郁。他们的平均年龄为61岁，其中60%是男性。干预组和对照组在ICU期间记录到的最高活动水平(ICU活动评分)平均值(95%CI)为7.3(6.3-8.3)，而对照组为5.9(4.9-6.9)，p=0.05。早期目标导向动员的患者在ICU中行走的比例几乎增加了一倍(干预n=19[66%]与对照组n=8[38%]；p=0.05)。干预组和对照组之间的住院总天数(D)没有差异(20[15-35]比34[18-43]；p=0.37)。没有不良事件发生。结论：关键练习要点：在随机对照试验中进行早期目标导向动员是可行的、安全的，并且可以增加积极运动的持续时间和水平。
Objectives: To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care.Design: A pilot randomized controlled trial.Setting: Five ICUs in Australia and New Zealand.Participants: Fifty critically ill adults mechanically ventilated for greater than 24 hours.Intervention: Patients were randomly assigned to either early goal-directed mobilization (intervention) or to standard care (control). Early goal-directed mobilization comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale while receiving mechanical ventilation.Measurements and Main Results: The ICU mobility scale, strength, ventilation duration, ICU and hospital length of stay, and total inpatient (acute and rehabilitation) stay as well as 6-month post-ICU discharge health-related quality of life, activities of daily living, and anxiety and depression were recorded. The mean age was 61 years and 60% were men. The highest level of activity (ICU mobility scale) recorded during the ICU stay between the intervention and control groups was mean (95% CI) 7.3 (6.3-8.3) versus 5.9 (4.9-6.9), p = 0.05. The proportion of patients who walked in ICU was almost doubled with early goal-directed mobilization (intervention n = 19 [66%] vs control n = 8 [38%]; p = 0.05). There was no difference in total inpatient stay (d) between the intervention versus control groups (20 [15-35] vs 34 [18-43]; p = 0.37). There were no adverse events.Conclusions: Key Practice Points: Delivery of early goal-directed mobilization within a randomized controlled trial was feasible, safe and resulted in increased duration and level of active exercises.