Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.
J Crit Care. 2013 Dec;28(6):980-4. doi: 10.1016/j.jcrc.2013.06.001. Epub 2013 Jul 9.
Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation.
A secondary analysis of a prospective cohort study was conducted.
The study was conducted in 11 ICUs in 3 teaching hospitals.
A total of 503 patients with ALI were included in the study.
No interventions were used in this study.
Thirty-four percent of patients ever received PT. In multivariable analysis, factors associated with later PT were a higher Sequential Organ Failure Assessment score (hazard ratio, 0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation (with daily sedation interruption: 0.49, 0.30-0.81; without daily sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital study site (2.84, 1.89-4.26).
In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.
机械通气患者早期开始物理治疗（PT）与改善预后相关。然而，PT 通常在拔管或离开重症监护病房（ICU）后才开始。我们评估了在没有强调早期康复的情况下入住 ICU 的急性肺损伤（ALI）患者开始 PT 的时间的相关因素。
对一项前瞻性队列研究进行了二次分析。
该研究在 3 家教学医院的 11 个 ICU 进行。
共有 503 名 ALI 患者纳入研究。
本研究未使用任何干预措施。
34%的患者接受过 PT。多变量分析显示，PT 较晚的相关因素包括序贯器官衰竭评估评分较高（风险比，0.89；95%置信区间，0.85-0.93）、吸入氧分数较高（0.97，0.96-0.98）、机械通气（0.31，0.16-0.59）、昏迷（0.32，0.20-0.51）、谵妄（0.72，0.50-1.03）和持续镇静（每日镇静中断：0.49，0.30-0.81；无每日镇静中断：0.59，0.39-0.89）。PT 较早的相关因素包括创伤的入院诊断（3.31，1.74-6.31）和医院研究地点（2.84，1.89-4.26）。
在没有强调早期康复的 11 个 ICU 中，ALI 患者经常未接受 PT。疾病严重程度、精神状态、镇静实践和医院地点是开始 PT 的重要障碍。了解这些障碍在引入早期 ICU 身体康复时可能很重要。
