Improving Post-Intensive Care Unit Neuropsychiatric Outcomes Understanding Cognitive Effects of Physical Activity
Improving Post-Intensive Care Unit Neuropsychiatric Outcomes Understanding Cognitive Effects of Physical Activity
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DOI：
10.1164/rccm.201206-1022cp
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发表时间：
2012-12-15
影响因子：
24.7
通讯作者：
Needham, Dale
中科院分区：
文献类型：
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作者：
Hopkins, Ramona O.;Suchyta, Mary R.;Needham, Dale
危重疾病及其治疗往往会导致长期的神经精神疾病。因此，有必要侧重于预防或改善这些疾病的手段。动物模型提供了有关体育活动的神经生物学效应的重要数据，包括血管生成、神经再生和增强可塑性的神经营养因子的释放。对非危重患者的研究表明，运动与脑血流量、神经发生和脑容量的增加有关，这与认知能力的改善有关。临床上，无论是健康受试者还是患病受试者的研究都表明，锻炼可以改善神经精神状态。在重症监护环境中，早期身体康复和动员是安全和可行的，并显示出身体功能结果的改善。这种活动还可能减少重症监护病房(ICU)的精神错乱持续时间，并改善神经精神病学结果，尽管数据有限。在常规护理中实施ICU康复存在障碍，包括使用镇静剂和缺乏对ICU后认知障碍的认识。有必要进行进一步的研究，以确定先前的动物和人类研究，结合现有ICU研究的初步结果，是否可以转化为改善危重患者的神经精神结局。需要研究来评估生物学机制、危险因素、ICU前功能水平的作用，以及体力活动的时间、持续时间和类型，以获得最佳的患者结果。
Critical illness and its treatment often result in long-term neuropsychiatric morbidities. Consequently, there is a need to focus on means to prevent or ameliorate these morbidities. Animal models provide important data regarding the neurobiological effects of physical activity, including angiogenesis, neurogenesis, and release of neurotrophic factors that enhance plasticity. Studies in noncritically ill patients demonstrate that exercise is associated with increased cerebral blood flow, neurogenesis, and brain volume, which are associated with improved cognition. Clinically, research in both healthy and diseased human subjects suggests that exercise improves neuropsychiatric outcomes. In the critical care setting, early physical rehabilitation and mobilization are safe and feasible, with demonstrated improvements in physical functional outcomes. Such activity may also reduce the duration of delirium in the intensive care unit (ICU) and improve neuropsychiatric outcomes, although data are limited. Barriers exist regarding implementing ICU rehabilitation in routine care, including use of sedatives and lack of awareness of post-ICU cognitive impairments. Further research is necessary to determine whether prior animal and human research, in conjunction with preliminary results from existing ICU studies, can translate into improvements for neuropsychiatric outcomes in critically ill patients. Studies are needed to evaluate biological mechanisms, risk factors, the role of pre-ICU functional level, and the timing, duration, and type of physical activity for optimal patient outcomes.