Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Indianapolis, IN.
Chest. 2013 Nov;144(5):1469-1480. doi: 10.1378/chest.13-0779.
ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.
MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.
Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.
The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.
美国的 ICU 入院人数一直在增加。在经历重病后，身体机能（PF）可能会受损长达 5 年。我们对评估 ICU 幸存者 PF 的干预措施的随机对照试验进行了系统评价。本研究的目的是确定能改善 ICU 幸存者长期 PF 的有效干预措施。
1990 年至 2012 年间，我们检索了 MEDLINE、Excerpta Medica Database（EMBASE）、Cumulative Index to Nursing and Allied Health Literature（CINAHL）和 Physiotherapy Evidence-Based Database（PEDro）。两位评审员独立评估了研究的合格性，对纳入的研究进行了严格评估，并将数据提取到标准化的证据表中。
14 项研究符合纳入标准。干预措施包括运动/物理治疗（PT）、肠外营养、护士主导的随访、自主唤醒试验、机械通气期间无镇静以及早期气管切开。有 9 项研究未能证明 ICU 幸存者 PF 的疗效。然而，早期的身体运动和基于 PT 的干预措施对长期 PF 有积极影响。
唯一能改善危重病患者长期 PF 的干预措施是运动/PT；如果更早开始，其益处可能更大。需要在该领域开展比较不同干预措施和时机的进一步研究。
