Fuest Kristina, Schaller Stefan J
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Curr Opin Anaesthesiol. 2018 Apr;31(2):144-150. doi: 10.1097/ACO.0000000000000568.
To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field.
Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsistent (e.g. stroke). Successful implementation of early mobilization requires a cultural change; preferably based on an interprofessional approach with clearly defined responsibilities and including a mobilization scoring system. Although the evidence for the majority of the technical tools is still limited, the use of a bed cycle ergometer and a treadmill with strap system has been promising in smaller trials.
Early mobilization is well tolerated and feasible, resulting in improved outcomes in surgical and medical ICU patients. Implementation of early mobilization can be challenging and may need a cultural change anchored in an interprofessional approach and integrated in a patient-centered bundle. Scoring systems should be integrated to define daily goals and used to verify patients' achievements or identify barriers immediately.
探讨早期活动的益处，并总结近期关于危重症患者早期活动的临床研究结果，随后介绍该领域的最新进展。
重症监护病房（ICU）患者的早期活动，定义为在入住ICU 72小时内开始活动，目前仍不常见。在内科和外科危重症患者中，即使是插管患者，活动也能得到良好耐受。在神经重症监护中，支持早期活动的证据要么缺乏（动脉瘤性蛛网膜下腔出血），要么结果不一致（如中风）。成功实施早期活动需要文化变革；最好基于明确界定职责的跨专业方法，并包括活动评分系统。尽管大多数技术工具的证据仍然有限，但在较小规模的试验中，使用床旁循环测力计和带绑带系统的跑步机已显示出前景。
早期活动耐受性良好且可行，可改善外科和内科ICU患者的预后。实施早期活动可能具有挑战性，可能需要以跨专业方法为基础并融入以患者为中心的综合措施的文化变革。应采用评分系统来确定每日目标，并用于核实患者的进展或立即识别障碍。
