Sricharoenchai Thiti, Parker Ann M, Zanni Jennifer M, Nelliot Archana, Dinglas Victor D, Needham Dale M
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Thammasat University, Pathum Thani, Thailand.
Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
J Crit Care. 2014 Jun;29(3):395-400. doi: 10.1016/j.jcrc.2013.12.012. Epub 2013 Dec 30.
Critical illness survivors commonly have impaired physical functioning. Physical therapy interventions delivered in the intensive care unit can reduce these impairments, but the safety of such interventions within routine clinical practice requires greater investigation.
We conducted a prospective observational study of routine physical therapy from July 2009 through December 2011 in the Johns Hopkins Hospital Medical Intensive Care Unit in Baltimore, MD. The incidence of 12 types of physiological abnormalities and potential safety events associated with physical therapy were monitored and evaluated for any additional treatment, cost, or length of stay.
Of 1787 admissions of at least 24 hours, 1110 (62%) participated in 5267 physical therapy sessions conducted by 10 different physical therapists on 4580 patient-days. A total of 34 (0.6%) sessions had a physiological abnormality or potential safety event, with the most common being arrhythmia (10 occurrences, 0.2%) and mean arterial pressure greater than 140 mm Hg (8 occurrences; 0.2%) and less than 55 mm Hg (5 occurrences; 0.1%). Only 4 occurrences (0.1%) required minimal additional treatment or cost, without additional length of stay.
In this large, single-center study, routine care physical therapy interventions were safe for critically ill patients.
危重症幸存者通常存在身体功能受损的情况。在重症监护病房进行的物理治疗干预可减轻这些损伤，但此类干预在常规临床实践中的安全性需要更多研究。
我们于2009年7月至2011年12月在马里兰州巴尔的摩市约翰霍普金斯医院医学重症监护病房对常规物理治疗进行了一项前瞻性观察研究。监测并评估了与物理治疗相关的12种生理异常和潜在安全事件的发生率，以及任何额外的治疗、费用或住院时间。
在1787例住院时间至少为24小时的患者中，1110例（62%）参与了由10名不同物理治疗师在4580个患者日进行的5267次物理治疗。共有34次（0.6%）治疗出现生理异常或潜在安全事件，最常见的是心律失常（10次，0.2%），平均动脉压大于140 mmHg（8次；0.2%）和小于55 mmHg（5次；0.1%）。只有4次（0.1%）需要极少的额外治疗或费用，且没有延长住院时间。
在这项大型单中心研究中，常规护理物理治疗干预对危重症患者是安全的。
