一项关于重症监护病房早期目标导向性活动的双边多中心试点可行性随机对照试验。

A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU.

作者信息

Hodgson Carol L, Bailey Michael, Bellomo Rinaldo, Berney Susan, Buhr Heidi, Denehy Linda, Gabbe Belinda, Harrold Megan, Higgins Alisa, Iwashyna Theodore J, Papworth Rebecca, Parke Rachael, Patman Shane, Presneill Jeffrey, Saxena Manoj, Skinner Elizabeth, Tipping Claire, Young Paul, Webb Steven

机构信息

1Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 2Alfred Hospital, Melbourne, VIC, Australia. 3Austin Health, Heidelberg, VIC, Australia. 4The University of Melbourne, Melbourne, VIC, Australia. 5Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 6Monash University, Melbourne, Melbourne, VIC, Australia. 7Curtin University, Bentley, WA, Australia. 8University of Michigan, Ann Arbor, MI. 9Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI. 10St Vincent's Hospital, Melbourne, VIC, Australia. 11Auckland City Hospital/Cardiovascular Intensive Care Unit, Auckland City, New Zealand. 12Fremantle Hospital, Fremantle, WA, Australia. 13Royal Brisbane and Women's Hospital, Herston, QLD, Australia. 14The George Institute for Global Health, Sydney, NSW, Australia. 15Western Hospital, Footscray, VIC, Australia. 16Wellington Hospital, Wellington, New Zealand. 17Royal Perth Hospital, Subiaco WA, Australia.

出版信息

Crit Care Med. 2016 Jun;44(6):1145-52. doi: 10.1097/CCM.0000000000001643.

DOI:10.1097/CCM.0000000000001643

PMID:26968024

Abstract

OBJECTIVES

To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care.

DESIGN

A pilot randomized controlled trial.

SETTING

Five ICUs in Australia and New Zealand.

PARTICIPANTS

Fifty critically ill adults mechanically ventilated for greater than 24 hours.

INTERVENTION

Patients were randomly assigned to either early goal-directed mobilization (intervention) or to standard care (control). Early goal-directed mobilization comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale while receiving mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS

The ICU mobility scale, strength, ventilation duration, ICU and hospital length of stay, and total inpatient (acute and rehabilitation) stay as well as 6-month post-ICU discharge health-related quality of life, activities of daily living, and anxiety and depression were recorded. The mean age was 61 years and 60% were men. The highest level of activity (ICU mobility scale) recorded during the ICU stay between the intervention and control groups was mean (95% CI) 7.3 (6.3-8.3) versus 5.9 (4.9-6.9), p = 0.05. The proportion of patients who walked in ICU was almost doubled with early goal-directed mobilization (intervention n = 19 [66%] vs control n = 8 [38%]; p = 0.05). There was no difference in total inpatient stay (d) between the intervention versus control groups (20 [15-35] vs 34 [18-43]; p = 0.37). There were no adverse events.

CONCLUSIONS

Key Practice Points: Delivery of early goal-directed mobilization within a randomized controlled trial was feasible, safe and resulted in increased duration and level of active exercises.

摘要

目的

确定与标准护理相比，早期目标导向性活动干预能否使接受机械通气的患者达到更高的最大活动水平。

设计

一项初步随机对照试验。

地点

澳大利亚和新西兰的5个重症监护病房。

参与者

50名接受机械通气超过24小时的成年重症患者。

干预措施

患者被随机分配至早期目标导向性活动组（干预组）或标准护理组（对照组）。早期目标导向性活动包括在患者接受机械通气期间，根据重症监护病房活动量表评估，在其所能达到的最高活动水平上进行功能康复治疗。

测量指标及主要结果

记录重症监护病房活动量表、肌力、通气时间、重症监护病房和住院时间、住院总时长（急性和康复期）以及重症监护病房出院后6个月的健康相关生活质量、日常生活活动能力、焦虑和抑郁情况。平均年龄为61岁，60%为男性。干预组和对照组在重症监护病房住院期间记录的最高活动水平（重症监护病房活动量表）均值（95%置信区间）分别为7.3（6.3 - 8.3）和5.9（4.9 - 6.9），p = 0.05。早期目标导向性活动使在重症监护病房内行走的患者比例几乎翻倍（干预组n = 19 [66%]，对照组n = 8 [38%]；p = 0.05）。干预组与对照组的住院总时长（天）无差异（20 [15 - 35] 对34 [18 - 43]；p = 0.37）。未发生不良事件。