Lee Hyun, Ko Young Jun, Jung Jinhee, Choi Aeng Ja, Suh Gee Young, Chung Chi Ryang
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Blood Purif. 2016;42(1):83-90. doi: 10.1159/000446175. Epub 2016 May 18.
BACKGROUND/AIMS: This study aims to evaluate potential safety events and vital sign changes during active mobilization physical therapy (PT) in critically ill patients undergoing continuous renal replacement therapy (CRRT).
A retrospective review was performed on 29 patients who were treated with CRRT and who underwent 81 PT sessions in a medical intensive care unit at a single referral hospital; 15 patients underwent 33 sessions with passive range of motion (PROM) and 17 patients underwent 48 active mobilization PT sessions. Three patients received both types of PT including 8 PROM and 5 active mobilization PT sessions. The occurrences of safety events and vital sign changes during active mobilization PT sessions were evaluated.
The safety events did not develop during 33 sessions with PROM. However, there were 2 safety events (4.1%) during 48 active mobilization PT sessions including one session with mobilization in the bed and the other in a sitting position on the edge of the bed. These safety events exclusively developed during active mobilization PT sessions, in which concomitant extracorporeal membrane oxygenation (ECMO) support and CRRT were delivered. Regarding vital sign changes during PT sessions, there were no significant differences in systolic blood pressure (BP), diastolic BP, mean arterial pressure, heart rate, respiratory rate, or peripheral oxygen saturation before and after both PROM and active mobilization PT sessions.
This study showed that active mobilization PT can be performed safely in patients who are being treated with CRRT without a significant hemodynamic change. However, the development of potential safety events in patients with ECMO needs to be monitored carefully.
背景/目的：本研究旨在评估接受持续肾脏替代治疗（CRRT）的重症患者在主动活动物理治疗（PT）期间的潜在安全事件和生命体征变化。
对一家转诊医院的医学重症监护病房中接受CRRT治疗且进行了81次PT治疗的29例患者进行回顾性研究；15例患者接受了33次被动关节活动度（PROM）治疗，17例患者接受了48次主动活动PT治疗。3例患者接受了两种类型的PT治疗，包括8次PROM治疗和5次主动活动PT治疗。评估主动活动PT治疗期间安全事件的发生情况和生命体征变化。
在33次PROM治疗期间未发生安全事件。然而，在48次主动活动PT治疗期间发生了2起安全事件（4.1%），其中1次是在床上活动，另1次是坐在床边时发生的。这些安全事件仅在主动活动PT治疗期间发生，当时同时进行了体外膜肺氧合（ECMO）支持和CRRT。关于PT治疗期间的生命体征变化，PROM和主动活动PT治疗前后的收缩压（BP）、舒张压、平均动脉压、心率、呼吸频率或外周血氧饱和度均无显著差异。
本研究表明，在接受CRRT治疗的患者中可以安全地进行主动活动PT，且不会有明显的血流动力学变化。然而，需要仔细监测接受ECMO治疗患者中潜在安全事件的发生情况。
