Clarissa Catherine, Salisbury Lisa, Rodgers Sheila, Kean Susanne
1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK.
2Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU UK.
J Intensive Care. 2019 Jan 17;7:3. doi: 10.1186/s40560-018-0355-z. eCollection 2019.
Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature.
Whittemore and Knafl's framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies.
Seventy-six studies were included from which four major themes were inferred: (1) , (2) , (3) and (4) . The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients' characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation.
This review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.
机械通气患者在重症监护入院后常出现肌肉无力。目前的证据表明，对这些患者进行早期活动可作为改善其预后的有效干预措施。然而，机械通气患者的早期活动（EM-MV）具体包括哪些内容仍不明确。我们旨在系统地探讨文献中EM-MV的定义和活动类型。
本综述以Whittemore和Knafl的框架为指导。检索了CINAHL、MEDLINE、EMBASE、PsycINFO、ASSIA和Cochrane图书馆，以获取2000年至2018年的研究，并结合对灰色文献的手工检索以及纳入研究的参考文献列表。使用批判性评估技能计划工具来评估纳入研究的方法学质量。每位评审员在分组讨论并达成一致之前，独立进行研究的数据提取和质量评估。对纳入研究中EM-MV定义和活动的逐字摘录进行归纳和数据驱动的主题分析。
纳入了76项研究，从中推断出四个主要主题：（1） ，（2） ，（3） 和（4） 。第一个主题表明，研究中要么未对EM-MV进行充分定义，要么在给出定义时，各研究之间未实现标准化。其余主题反映了EM-MV活动的多样性，这取决于患者的特征和重症监护病房的环境；患者与工作人员之间的协商决策过程；以及实施过程中他们的相互依存关系。
本综述强调了在机械通气患者早期活动的定义以及具体构成方面缺乏共识。为了推动研究和实践，达成一致且共享的定义是先决条件。
