Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, USA.
Crit Care Med. 2010 Nov;38(11):2089-94. doi: 10.1097/CCM.0b013e3181f270c3.
Physical and occupational therapy are possible immediately after intubation in mechanically ventilated medical intensive care unit patients. The objective of this study was to describe a protocol of daily sedative interruption and early physical and occupational therapy and to specify details of intensive care unit-based therapy, including neurocognitive state, potential barriers, and adverse events related to this intervention.
Detailed descriptive study of the intervention arm of a trial of mechanically ventilated patients receiving early physical and occupational therapy.
Two tertiary care academic medical centers participating in a randomized controlled trial.
Patients underwent daily sedative interruption followed by physical and occupational therapy every hospital day until achieving independent functional status. Therapy began with active range of motion and progressed to activities of daily living, sitting, standing, and walking as tolerated.
Forty-nine mechanically ventilated patients received early physical and occupational therapy occurring a median of 1.5 days (range, 1.0-2.1 days) after intubation. Therapy was provided on 90% of MICU days during mechanical ventilation. While endotracheally intubated, subjects sat at the edge of the bed in 69% of all physical and occupational therapy sessions, transferred from bed to chair in 33%, stood in 33%, and ambulated during 15% (n = 26 of 168) of all physical and occupational therapy sessions (median distance of 15 feet; range, 15-20 feet). At least one potential barrier to mobilization during mechanical ventilation (acute lung injury, vasoactive medication administration, delirium, renal replacement therapy, or body mass index ≥ 30 kg/m) was present in 89% of patient encounters. Therapy was interrupted prematurely in 4% of all sessions, most commonly for patient-ventilator asynchrony and agitation.
Early physical and occupational therapy is feasible from the onset of mechanical ventilation despite high illness acuity and presence of life support devices. Adverse events are uncommon, even in this high-risk group.
在机械通气的医疗重症监护病房患者中，在插管后即可进行物理治疗和职业治疗。本研究的目的是描述一种每日镇静中断及早期物理治疗和职业治疗的方案，并详细说明基于重症监护病房的治疗，包括神经认知状态、潜在障碍以及与该干预相关的不良事件。
对接受早期物理治疗和职业治疗的机械通气患者的试验的干预组进行详细描述性研究。
参加随机对照试验的两个三级保健学术医疗中心。
患者接受每日镇静中断，然后在每个住院日进行物理治疗和职业治疗，直到达到独立的功能状态。治疗从主动运动范围开始，进展到日常生活活动、坐、站和行走，视耐受情况而定。
49 名机械通气患者在插管后中位数为 1.5 天（范围 1.0-2.1 天）接受早期物理治疗和职业治疗。在机械通气期间，治疗在 90%的 MICU 日进行。在气管内插管期间，受试者在所有物理治疗和职业治疗课程中有 69%坐在床边，33%从床上转移到椅子上，33%站立，在 15%（n = 168 中的 26）的所有物理治疗和职业治疗课程中行走（中位数距离为 15 英尺；范围 15-20 英尺）。在 89%的患者就诊中，存在至少一种机械通气时活动障碍的潜在障碍（急性肺损伤、血管活性药物治疗、谵妄、肾脏替代治疗或 BMI≥30kg/m）。所有课程中，有 4%的课程提前中断，最常见的原因是患者与呼吸机不同步和躁动。
尽管疾病严重程度高且存在生命支持设备，但在机械通气开始后即可进行早期的物理治疗和职业治疗。即使在这个高风险人群中，不良事件也很少见。
