Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA.
Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
Support Care Cancer. 2020 Feb;28(2):747-753. doi: 10.1007/s00520-019-04867-1. Epub 2019 May 29.
To determine the level of recall, satisfaction, and perceived benefits of early mobility (EM) among ventilated cancer patients after extubation in the intensive care unit (ICU).
A survey of patients' perceptions and recollections of EM was administered within 72 h of extubation. Data on recall of EM participation, activities achieved, adequacy of staffing and rest periods, strength to participate, activity level of difficulty, satisfaction with staff instructions, breathing management, and overall rating of the experience were analyzed. The Confusion Assessment Method for ICU (CAM-ICU) was used for delirium screening.
Fifty-four patients comprised the study group. Nearly 90% reported satisfaction with instructions, staffing, rest periods, and breathing management during EM. Participants indicated that EM maintained their strength (67%) and gave them control over their recovery (61%); a minority felt optimistic (37%) and safe (22%). Patients who achieved more sessions and "out-of-bed" exercises had better recall of actual activities compared with those who exercised in bed. Overall, patients with CAM-ICU-positive results (33%) performed less physical and occupational therapy exercises.
Ventilated cancer patients reported an overall positive EM experience, but factual memory impairment of EM activities was common. These findings highlight the needs and the importance of shaping strategies to deliver a more patient focused EM experience.
确定在重症监护病房(ICU)拔管后接受通气的癌症患者对早期活动(EM)的回忆、满意度和感知益处的水平。
在拔管后 72 小时内对患者对 EM 的感知和回忆进行调查。分析了对 EM 参与、完成的活动、人员配备和休息时间的充足性、参与的体力、活动难度水平、对员工指导、呼吸管理和整体体验的满意度的数据。使用 ICU 意识混乱评估方法(CAM-ICU)进行谵妄筛查。
54 名患者组成了研究组。近 90%的患者对 EM 期间的指导、人员配备、休息时间和呼吸管理表示满意。参与者表示,EM 保持了他们的体力(67%),并让他们能够掌控自己的康复(61%);少数人感到乐观(37%)和安全(22%)。与仅在床上锻炼的患者相比,进行更多次“离床”锻炼的患者对实际活动的记忆更好。总体而言,CAM-ICU 阳性结果(33%)的患者进行的物理和职业治疗锻炼较少。
通气的癌症患者报告了整体上积极的 EM 体验,但对 EM 活动的事实记忆障碍很常见。这些发现强调了满足需求和制定更以患者为中心的 EM 体验策略的重要性。