Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Crit Care Med. 2013 Jun;41(6):1543-54. doi: 10.1097/CCM.0b013e31827ca637.
The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
Using keywords critical care and physical therapy and related synonyms, randomized controlled trials, meta-analyses, and systematic reviews were identified through electronic database searches and citation tracking. Clinical trials with outcomes of mortality, length of hospital and ICU stay, physical function and quality of life, muscle strength, and ventilator-free days were included.
Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were calculated. From 3,126 screened abstracts, 10 randomized controlled trials and five reviews were found. The mean Physiotherapy Evidence Database score was 5.4. Overall there was a significant positive effect favoring physical therapy for the critically ill to improve the quality of life (g = 0.40, 95% confidence interval 0.08, 0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78), peripheral muscle strength (g = 0.27, 95% confidence interval 0.02, 0.52), and respiratory muscle strength (g = 0.51, 95% confidence interval 0.12, 0.89). Length of hospital (g = -0.34, 95% confidence interval -0.53, -0.15) and ICU stay (g = -0.34, 95% confidence interval -0.51, -0.18) significantly decreased and ventilator-free days increased (g = 0.38, 95% confidence interval 0.16, 0.59) following physical therapy in the ICU. There was no effect on mortality.
Physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay. However, further controlled trials of better quality and larger sample sizes are required to verify the strength of these tentative associations.
本系统综述的目的是回顾危重症患者运动的证据基础。
使用关键护理和物理治疗及相关同义词作为关键词，通过电子数据库搜索和引文追踪，确定了随机对照试验、荟萃分析和系统评价。纳入了死亡率、住院和 ICU 住院时间、身体功能和生活质量、肌肉力量和无呼吸机天数等结局的临床试验。
两名评审员独立提取数据并评估质量。计算了效应大小和 95%置信区间。从 3126 篇筛选的摘要中，发现了 10 项随机对照试验和 5 项综述。物理治疗证据数据库的平均得分为 5.4。总体而言，物理治疗对改善生活质量（g = 0.40，95%置信区间 0.08，0.71）、身体功能（g = 0.46，95%置信区间 0.13，0.78）、外周肌肉力量（g = 0.27，95%置信区间 0.02，0.52）和呼吸肌力量（g = 0.51，95%置信区间 0.12，0.89）有显著的积极影响。物理治疗后 ICU 住院时间（g = -0.34，95%置信区间 -0.53，-0.15）和 ICU 住院时间（g = -0.34，95%置信区间 -0.51，-0.18）显著降低，无呼吸机天数增加（g = 0.38，95%置信区间 0.16，0.59）。但对死亡率无影响。
在 ICU 中进行物理治疗似乎可以显著改善生活质量、身体功能、外周和呼吸肌力量、增加无呼吸机天数，并缩短住院和 ICU 住院时间。然而，需要进一步开展高质量、大样本量的对照试验来验证这些初步关联的强度。
