Department of Anesthesiology and Intensive Care, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Intensive Care Med. 2019 Feb;45(2):201-210. doi: 10.1007/s00134-019-05528-x. Epub 2019 Jan 21.
Early mobilization within 72 h of intensive care unit (ICU) admission improves functional status at hospital discharge. We aimed to assess the effectiveness of early, goal-directed mobilization in critically ill patients across a broad spectrum of initial consciousness levels.
Post hoc analysis of the international, randomized, controlled, outcome-assessor blinded SOMS trial conducted 2011-2015. Randomization was stratified according to the immediate post-injury Glasgow Coma Scale (GCS) (≤ 8 or > 8). Patients received either SOMS-guided mobility treatment with a facilitator or standard care. We used general linear models to test the hypothesis that immediate post-randomization GCS modulates the intervention effects on functional independence at hospital discharge.
Two hundred patients were included in the intention-to-treat analysis. The significant effect of early, goal-directed mobilization was consistent across levels of GCS without evidence of effect modification, for the primary outcome functional independence at hospital discharge (p = 0.53 for interaction), as well as average achieved mobility level during ICU stay (mean achieved SOMS level) and functional status at hospital discharge measured with the functional independence measure. In patients with low GCS, delay to first mobilization therapy was longer (0.7 ± 0.2 days vs. 0.2 ± 0.1 days, p = 0.008), but early, goal-directed mobilization compared with standard care significantly increased functional independence at hospital discharge in this subgroup of patients with immediate post-randomization GCS ≤ 8 (OR 3.67; 95% CI 1.02-13.14; p = 0.046).
This post hoc analysis of a randomized controlled trial suggests that early, goal-directed mobilization in patients with an impaired initial conscious state (GCS ≤ 8) is not harmful but effective.
在重症监护病房（ICU）入院后 72 小时内进行早期动员可改善出院时的功能状态。我们旨在评估在广泛初始意识水平的危重患者中，早期、目标导向的动员的有效性。
对 2011 年至 2015 年进行的国际、随机、对照、结局评估者盲法 SOMS 试验进行事后分析。随机分组根据受伤后即刻格拉斯哥昏迷量表（GCS）（≤8 或>8）分层。患者接受 SOMS 指导的移动治疗（有促进者）或标准护理。我们使用一般线性模型来检验以下假设：即刻随机分组后的 GCS 调节干预对出院时功能独立性的影响。
200 例患者纳入意向治疗分析。早期、目标导向的动员的显著效果在 GCS 水平上一致，没有证据表明存在效应修饰，主要结局为出院时的功能独立性（交互作用 p=0.53），以及 ICU 期间平均达到的移动水平（平均达到的 SOMS 水平）和功能独立性测量工具（FIM）出院时的功能状态。在 GCS 较低的患者中，首次动员治疗的延迟时间更长（0.7±0.2 天 vs. 0.2±0.1 天，p=0.008），但与标准护理相比，早期、目标导向的动员在随机分组后即刻 GCS≤8 的患者亚组中显著增加了出院时的功能独立性（OR 3.67；95%CI 1.02-13.14；p=0.046）。
这项随机对照试验的事后分析表明，在初始意识状态受损（GCS≤8）的患者中进行早期、目标导向的动员并非有害，而是有效的。
