Physiotherapy Unit, Hôpital Marie Lannelongue, Le Plessis Robinson, Université Paris Sud, Paris, France.
Cardiothoracic Intensive Care Unit, Hôpital Marie Lannelongue, Le Plessis Robinson, Université Paris Sud, Paris, France.
J Crit Care. 2018 Aug;46:37-43. doi: 10.1016/j.jcrc.2018.03.031. Epub 2018 Apr 5.
To investigate whether passive tilting added to a standardized rehabilitation therapy improved strength at Intensive Care Unit (ICU) discharge.
This single-center trial included patients admitted to an adult surgical ICU and ventilated for at least 3 days. Patients were randomized to daily standardized rehabilitation therapy alone or with tilting on a table for at least 1 h. The primary outcome was the Medical Research Council (MRC) sum score at ICU discharge. Muscular recovery was a secondary outcome.
Of 145 included patients, 125 received mobilization, 65 in the Tilt group and 60 in the Control group. Total mobilization duration (median [25th–75th percentiles]) in the Tilt group was 1020 [580–1695] versus 1340 [536–2775] minutes in the Control group (p = 0.313). MRC sum scores at ICU discharge were not significantly different between groups (Tilt, 50 [45–56] versus 48 [45–54]; p = 0.555). However, the number of patients with weakness was higher in the Tilt group at baseline (Tilt: 60/65 versus 48/60, p = 0.045) and muscular recovery was better in the Tilt group (p = 0.004).
Passive tilting added to a standardized rehabilitation therapy did not improve muscle strength at ICU discharge in surgical patients even if a faster recovery with tilting is suggested.
研究在标准化康复治疗的基础上增加被动倾斜是否能改善重症监护病房（ICU）出院时的力量。
这项单中心试验纳入了至少接受过 3 天机械通气的成年外科 ICU 患者。患者被随机分为仅接受每日标准化康复治疗或每天至少接受 1 小时倾斜治疗。主要结局是 ICU 出院时的医学研究理事会（MRC）总和评分。肌肉恢复是次要结局。
在纳入的 145 名患者中，125 名接受了活动，65 名在倾斜组，60 名在对照组。倾斜组的总活动时间（中位数[25 至 75 百分位数]）为 1020 [580-1695]分钟，而对照组为 1340 [536-2775]分钟（p = 0.313）。ICU 出院时 MRC 总和评分在两组间无显著差异（倾斜组：50 [45-56] vs. 48 [45-54]；p = 0.555）。然而，在基线时倾斜组有更多的患者存在虚弱（倾斜组：60/65 比 48/60，p = 0.045），且倾斜组的肌肉恢复更好（p = 0.004）。
在外科患者中，在标准化康复治疗的基础上增加被动倾斜并不能改善 ICU 出院时的肌肉力量，尽管倾斜可能会更快地恢复。
