Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France.
Respir Care. 2010 Apr;55(4):400-7.
Prolonged immobilization may harm intensive care unit (ICU) patients, and early mobilization has been proposed to counteract that process. We describe our experience in early rehabilitation of ICU patients, and its effects on physiologic outcomes.
We included all patients who stayed in our 14-bed medical ICU for > or = 7 days and received invasive mechanical ventilation for > or = 2 days. The rehabilitation program included chair-sitting, tilting-up (with arms supported or unsupported), and walking. We collected vital signs before and after each intervention.
Over a 5-month period we studied 20 patients, after a median ICU stay of 5 days. A contraindication to the intervention was present on 230 days (43%). Sedation (15%), shock (11%), and renal support (9%) were the most frequent contraindications. We obtained complete data from 275 of 424 interventions, 33% of which were performed during mechanical ventilation. The chair-sitting intervention was the most frequent (56%), followed by the tilting-up-with-arms-unsupported intervention (25%), the walking intervention (11%), and the tilting-up arms-supported intervention (8%). The chair-sitting intervention was associated with a significant (P = .03) decline in both heart rate (mean -3.5 beats/min, 95% confidence interval [CI] -6.5 to -0.4 beats/min) and respiratory rate (-1.4 breaths/min, 95% CI -2.6 to 0.1 breaths/min), whereas blood oxygen saturation (measured via pulse oximetry [S(pO(2))]) and mean arterial blood pressure did not change significantly. Heart rate and respiratory rate similarly increased with tilting-up: 14.6 beats/min, 95% CI 10.8 to 18.4 beats/min, and 5.5 breaths/min, 95% CI 3.6 to 7.3 breaths/min with arms unsupported, and 12.4 beats/min, 95% CI 7.0 to 17.9 beats/min and 2.6 breaths/min, 95% CI -0.4 to 5.7 breaths/min with arms supported). Heart rate and respiratory rate also increased with the walking intervention: 6.9 beats/min, 95% CI 2.6 to 11.1 beats/min, and 5.9 breaths/min, 95% CI 3.8 to 8.0 breaths/min. The walking intervention significantly decreased S(pO(2)). An adverse event occurred in 13 (3%) of 424 interventions, but none had harmful consequences.
Early rehabilitation is feasible and safe in patients in the ICU for longer than 1 week. The chair-sitting intervention was associated with nonsignificant oxygenation improvement. The tilting-up intervention was an effort as intense as walking.
长时间的卧床会对重症加强护理病房（ICU）的患者造成损害，因此提出早期活动以对抗这种损害。我们介绍 ICU 患者早期康复的经验及其对生理结果的影响。
我们纳入了所有在我们 14 张床位的内科 ICU 住院时间超过 7 天且接受了超过 2 天有创机械通气的患者。康复计划包括坐椅子、倾斜（支撑或不支撑手臂）和行走。我们在每次干预前后收集生命体征。
在 5 个月的时间里，我们研究了 20 名患者，他们在 ICU 的中位停留时间为 5 天。有 230 天（43%）存在干预禁忌。镇静（15%）、休克（11%）和肾脏支持（9%）是最常见的禁忌。我们从 424 次干预中的 275 次获得了完整的数据，其中 33%是在机械通气期间进行的。坐椅子的干预最常见（56%），其次是不支撑手臂的倾斜（25%）、行走干预（11%）和支撑手臂的倾斜（8%）。坐椅子的干预与心率（平均-3.5 次/分钟，95%置信区间 [CI] -6.5 至 -0.4 次/分钟）和呼吸频率（-1.4 次/分钟，95%CI -2.6 至 0.1 次/分钟）的显著下降相关，而脉搏血氧饱和度（通过脉搏血氧仪[S(pO(2))]测量）和平均动脉压没有明显变化。不支撑手臂的倾斜同样使心率和呼吸率增加：14.6 次/分钟，95%CI 10.8 至 18.4 次/分钟和 5.5 次/分钟，95%CI 3.6 至 7.3 次/分钟，而支撑手臂的倾斜使心率和呼吸率分别增加 12.4 次/分钟，95%CI 7.0 至 17.9 次/分钟和 2.6 次/分钟，95%CI -0.4 至 5.7 次/分钟。行走干预同样使心率和呼吸率增加：6.9 次/分钟，95%CI 2.6 至 11.1 次/分钟和 5.9 次/分钟，95%CI 3.8 至 8.0 次/分钟。行走干预显著降低了 S(pO(2))。424 次干预中有 13 次（3%）发生不良事件，但均无不良后果。
在 ICU 住院时间超过 1 周的患者中，早期康复是可行和安全的。坐椅子干预与氧合改善不显著相关。倾斜干预与行走一样费力。
