Lai Chih-Cheng, Chou Willy, Chan Khee-Siang, Cheng Kuo-Chen, Yuan Kuo-Shu, Chao Chien-Ming, Chen Chin-Ming
Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Arch Phys Med Rehabil. 2017 May;98(5):931-939. doi: 10.1016/j.apmr.2016.11.007. Epub 2016 Dec 13.
To evaluate the effects of a quality improvement program to introduce early mobilization on the outcomes of patients with mechanical ventilation (MV) in the intensive care unit (ICU).
A retrospective observational study.
Nineteen-bed ICU at a medical center.
Adults patients with MV (N=153) admitted to a medical ICU.
A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, patient's family) initiated the protocol within 72 hours of MV when patients become hemodynamically stable. We did early mobilization twice daily, 5d/wk during family visits (30min each time), and cooperated with family, if possible.
MV duration, rate of successful weaning, and length of ICU and hospital stay.
We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body weight, body mass index, disease severity, cause of intubation, number of comorbidities, and most underlying diseases. After protocol group patients had shorter MV durations (4.7d vs 7.5d; P<.001) and ICU stays (6.9d vs 9.9d; P=.001) than did before protocol group patients. Early mobilization was negatively associated with the duration of MV (β=-.269; P<.002; 95% confidence interval [CI], -4.767 to -1.072), and the risk of MV for ≥7 days was lower in patients who underwent early mobilization (odds ratio, .082; 95% CI, .021-.311).
The introduction of early mobilization for patients with MV in the ICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient's family can work together to improve the patient's clinical outcomes.
评估一项引入早期活动的质量改进计划对重症监护病房（ICU）中机械通气（MV）患者预后的影响。
一项回顾性观察研究。
某医疗中心拥有19张床位的ICU。
入住医疗ICU的成年MV患者（N = 153）。
一个多学科团队（重症护理护士、护理助理、呼吸治疗师、物理治疗师、患者家属）在MV患者血流动力学稳定后的72小时内启动该方案。我们每天进行两次早期活动，每周5天，在家属探视期间（每次30分钟），并尽可能与家属合作。
MV持续时间、成功脱机率、ICU住院时间和住院时间。
我们在方案实施前组纳入了63例患者，在方案实施后组纳入了90例患者。两组在年龄、性别、身高、体重、体重指数、疾病严重程度、插管原因、合并症数量以及大多数基础疾病方面匹配良好。方案实施后组患者的MV持续时间（4.7天对7.5天；P <.001）和ICU住院时间（6.9天对9.9天；P =.001）均短于方案实施前组患者。早期活动与MV持续时间呈负相关（β = -.269；P <.002；95%置信区间[CI]，-4.767至-1.072），接受早期活动的患者MV持续≥7天的风险较低（比值比，.082；95%CI，.021 -.311）。
在ICU中对MV患者引入早期活动可缩短MV持续时间和ICU住院时间。一个包括患者家属在内的多学科团队可以共同努力改善患者的临床结局。
