危重症成年患者的早期活动：对加拿大医生和物理治疗师的知识、认知及实践的一项调查
Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists.
作者信息
Koo Karen K Y, Choong Karen, Cook Deborah J, Herridge Margaret, Newman Anastasia, Lo Vincent, Guyatt Gordon, Priestap Fran, Campbell Eileen, Burns Karen E A, Lamontagne FranÇois, Meade Maureen O
机构信息
Department of Medicine (Koo), Western University, London, Ont.; Department of Pediatrics (Choong); Department of Medicine (Choong, Cook, Guyatt, Meade); Department of Clinical Epidemiology and Biostatistics (Choong, Cook, Guyatt, Meade), McMaster University, Hamilton, Ont.; Department of Medicine (Herridge, Burns), University of Toronto; Hamilton General Hospital (Newman, Meade), Hamilton, Ont.; University Health Network (Lo), Toronto General Hospital, Toronto, Ont.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke and Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Swedish Medical Group (Koo, Priestap, Campbell), Seattle, Wash.
出版信息
CMAJ Open. 2016 Aug 18;4(3):E448-E454. doi: 10.9778/cmajo.20160021. eCollection 2016 Jul-Sep.
BACKGROUND
The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU).
METHODS
We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012. To identify all physicians and physiotherapists working in the ICUs, we contacted division heads and senior physiotherapists by telephone or email. We designed, tested and administered a questionnaire with the following domains: knowledge of ICU-acquired weakness and early mobilization; personal views of, perceived barriers to and adequacy of technical skills for early mobilization; assessments for initiation of early mobilization and permissible activity levels by patient physiologic characteristics, diagnoses and therapies; staffing issues; and sedation practices.
RESULTS
The overall response rate was 71.3% (311/436); it was 64.2% (194/302) among physicians and 87.3% (117/134) among physiotherapists. A total of 214 respondents (68.8%) underestimated the incidence of ICU-acquired weakness in the general medical-surgical ICU population, and 186 (59.8%) stated they had insufficient knowledge or skills to mobilize patients receiving mechanical ventilation. Excessive sedation, medical instability, limited staffing, safety concerns, insufficient guidelines and insufficient equipment were common perceived barriers to early mobilization.
INTERPRETATION
Physicians and physiotherapists in the ICU underestimated the incidence of ICU-acquired weakness and felt inadequately trained to mobilize patients receiving mechanical ventilation. We identified multiple modifiable barriers to early mobilization at the institutional, health care provider and patient levels that need to be addressed when designing mobilization programs for critically ill adults.
背景
重症疾病后早期活动的推广受到全国性报告中所提及的患者和机构层面实施该方法的障碍的影响。我们开展了一项调查，以评估加拿大医生和物理治疗师关于成人重症监护病房（ICU）中获得性肌无力和早期活动的现有知识、看法及实践情况。
方法
2011 - 2012年，我们对加拿大所有46个学术性ICU中的重症监护医生和物理治疗师进行了一项横断面、自我管理的邮寄调查。为确定所有在ICU工作的医生和物理治疗师，我们通过电话或电子邮件联系了科室主任和资深物理治疗师。我们设计、测试并发放了一份包含以下领域的问卷：对ICU获得性肌无力和早期活动的知识；对早期活动的个人看法、感知到的障碍以及技术技能的充分性；根据患者生理特征、诊断和治疗情况对早期活动起始及允许的活动水平进行评估；人员配备问题；以及镇静实践。
结果
总体回复率为71.3%（311/436）；医生的回复率为64.2%（194/302），物理治疗师的回复率为87.3%（117/134）。共有214名受访者（68.8%）低估了普通内科 - 外科ICU人群中ICU获得性肌无力的发生率，186名（59.8%）表示他们缺乏足够的知识或技能来为接受机械通气的患者进行活动。过度镇静、病情不稳定、人员配备有限、安全担忧、指南不足以及设备不足是早期活动常见的感知障碍。
解读
ICU中的医生和物理治疗师低估了ICU获得性肌无力的发生率，并且感觉在为接受机械通气的患者进行活动方面培训不足。我们确定了在机构、医疗服务提供者和患者层面存在多个可改变的早期活动障碍，在为重症成人设计活动计划时需要加以解决。
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