Borges Vanessa Marcos, Oliveira Luiz Rogério Carvalho de, Peixoto Elzo, Carvalho Nilza Aparecida Almeida de
Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.
Serviço de Terapia Intensiva, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ter Intensiva. 2009 Dec;21(4):446-52.
This study aimed to review the literature addressing motor physical therapy for intensive care unit adult patients. A literature search was conducted in the databases, PubMed, MedLine (International Literature and Health), LILACS (Latin American and Caribbean Health Sciences) and Cochrane between 1995 and December 2008 using the keywords: physical therapy, mobilization and intensive care unit. For comparison purposes we selected randomized controlled trials and prospective studies, addressing the subject motor physical therapy for intensive care unit adult patients. Pediatric and experimental studies, systematic reviews and meta-analysis were excluded. Of the 121 articles identified, only 4 met the inclusion criteria. Among these, three focused early motor physical therapy in patients with a range of diagnoses, showing that these patients left the bed and walked earlier, and stayed shorter both in the intensive care unit and hospital. Furthermore, patients on early motor physical therapy had shorter mechanical ventilation duration. Another paper compares the use of electrical stimulation associated with physical therapy in chronic obstructive pulmonary disease patients, showing increased muscle strength and shorter time for these patients bed to chair transference as compared with those only receiving physiotherapy. The risks of immobilization in mechanically ventilated critically ill patients are not fully understood. However, it is clear that the survivors show impaired quality of life due to persistent weakness and fatigue. Early mobilization is a new area, with little evidence so far. However, recent studies have confirmed that mechanically ventilated patients mobilization is safe and feasible, reducing both the intensive care unit and hospital stay. However, more studies are warranted to identify the exercise type, duration, intensity and impact for of early motor therapy in specific groups of patients.
本研究旨在回顾关于重症监护病房成年患者运动物理治疗的文献。于1995年至2008年12月期间，在PubMed、MedLine（国际文献与健康）、LILACS（拉丁美洲和加勒比健康科学）以及Cochrane等数据库中进行文献检索，使用的关键词为：物理治疗、活动以及重症监护病房。为作比较，我们选取了针对重症监护病房成年患者运动物理治疗这一主题的随机对照试验和前瞻性研究。儿科研究、实验性研究、系统评价和荟萃分析均被排除。在检索出的121篇文章中，仅有4篇符合纳入标准。其中，3篇聚焦于对一系列诊断患者的早期运动物理治疗，结果显示这些患者更早离床行走，在重症监护病房和医院的停留时间均更短。此外，接受早期运动物理治疗的患者机械通气时间更短。另一篇论文比较了物理治疗联合电刺激在慢性阻塞性肺疾病患者中的应用，结果表明与仅接受物理治疗的患者相比，这些患者肌肉力量增强，从床上转移至椅子所需时间更短。机械通气的危重症患者制动的风险尚未完全明了。然而，显然幸存者因持续的虚弱和疲劳而生活质量受损。早期活动是一个新领域，目前证据较少。然而，近期研究已证实机械通气患者的活动是安全可行的，可缩短重症监护病房和医院的住院时间。然而，仍需要更多研究来确定早期运动治疗在特定患者群体中的运动类型、持续时间、强度及影响。
