Physiotherapy Department, Royal Adelaide Hospital, Adelaide, SA, Australia.
Chest. 2013 Sep;144(3):825-847. doi: 10.1378/chest.12-2930.
Although physiotherapy is frequently provided to patients in the ICU, its role has been questioned. The purpose of this systematic literature review, an update of one published in 2000, was to examine the evidence concerning the effectiveness of physiotherapy for adult, intubated patients who are mechanically ventilated in the ICU.
The main literature search was undertaken on PubMed, with secondary searches of MEDLINE, CINAHL, Embase, the Cochrane Library, and the Physiotherapy Evidence Database. Only papers published from 1999 were included. No limitations were placed on study design, intervention type, or outcomes of clinical studies; nonsystematic reviews were excluded. Items were checked for relevance and data extracted from included studies. Marked heterogeneity of design precluded statistical pooling of results and led to a descriptive review.
Fifty-five clinical and 30 nonclinical studies were reviewed. The evidence from randomized controlled trials evaluating the effectiveness of routine multimodality respiratory physiotherapy is conflicting. Physiotherapy that comprises early progressive mobilization has been shown to be feasible and safe, with data from randomized controlled trials demonstrating that it can improve function and shorten ICU and hospital length of stay.
Available new evidence, published since 1999, suggests that physiotherapy intervention that comprises early progressive mobilization is beneficial for adult patients in the ICU in terms of its positive effect on functional ability and its potential to reduce ICU and hospital length of stay. These new findings suggest that early progressive mobilization should be implemented as a matter of priority in all adult ICUs and an area of clinical focus for ICU physiotherapists.
尽管物理疗法经常在 ICU 中提供给患者，但它的作用一直受到质疑。本次系统文献回顾的目的是检查有关对 ICU 中接受机械通气的成年插管患者进行物理疗法的有效性的证据，这是对 2000 年发表的一篇文献的更新。
主要文献检索在 PubMed 上进行，对 MEDLINE、CINAHL、Embase、Cochrane 图书馆和物理治疗证据数据库进行了二次检索。仅纳入了 1999 年以后发表的论文。对临床研究的设计、干预类型或结果没有限制；排除了非系统性综述。对相关项目进行了检查，并从纳入的研究中提取了数据。由于设计存在明显的异质性，结果无法进行统计学汇总，因此进行了描述性综述。
共回顾了 55 项临床研究和 30 项非临床研究。评估常规多模式呼吸物理疗法有效性的随机对照试验的证据存在矛盾。已证明包含早期渐进性运动的物理疗法是可行且安全的，随机对照试验的数据表明，它可以改善功能并缩短 ICU 和住院时间。
自 1999 年以来发表的新证据表明，包含早期渐进性运动的物理治疗干预对 ICU 中的成年患者有益，可对其功能能力产生积极影响，并可能缩短 ICU 和住院时间。这些新发现表明，应优先在所有成人 ICU 中实施早期渐进性运动，并将其作为 ICU 物理治疗师的临床重点领域。
