Mendez-Tellez Pedro A, Nusr Rasha, Feldman Dorianne, Needham Dale M
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurohospitalist. 2012 Jul;2(3):96-105. doi: 10.1177/1941874412447631.
Advances in critical care have resulted in improved intensive care unit (ICU) mortality. However, improved ICU survival has resulted in a growing number of ICU survivors living with long-term sequelae of critical illness, such as impaired physical function and quality of life (QOL). In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. ICU-acquired weakness is associated with increased duration of mechanical ventilation and weaning, longer ICU and hospital stay, and increased mortality. These physical impairments may last for years after ICU discharge. Early Physical Medicine and Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent the weakness and physical impairments occurring during critical illness. This article reviews the evidence regarding safety, feasibility, barriers, and benefits of early PM&R interventions in ICU patients and discusses the limited existing data on early PM&R in the neurological ICU and future directions for early PM&R in the ICU.
重症监护的进展已使重症监护病房（ICU）的死亡率有所改善。然而，ICU生存率的提高导致越来越多的ICU幸存者伴有危重病的长期后遗症，如身体功能受损和生活质量（QOL）下降。除了危重病外，长期卧床休息和活动受限可能导致严重的身体机能减退、肌肉量减少和肌肉无力。ICU获得性肌无力与机械通气和撤机时间延长、ICU和住院时间延长以及死亡率增加有关。这些身体损伤可能在ICU出院后持续数年。在ICU早期进行物理医学与康复（PM&R）干预可能会减轻或预防危重病期间出现的肌无力和身体损伤。本文综述了有关ICU患者早期PM&R干预的安全性、可行性、障碍和益处的证据，并讨论了神经ICU中早期PM&R的现有有限数据以及ICU早期PM&R的未来方向。
