Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA.
Department of Medicine, David Geffen School of Medicine at UCLA, 8783University of California, Los Angeles, CA, USA.
J Intensive Care Med. 2020 Nov;35(11):1323-1331. doi: 10.1177/0885066619863654. Epub 2019 Jul 22.
In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy to measure patient activity in the ICU setting.
We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016.
Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in ≥5 ICU patients.
Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts.
Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay.
Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting.
在重症监护病房（ICU）中，长时间不活动很常见，增加了患者发生不良后果的风险，包括 ICU 获得性肌无力。因此，旨在减少不活动的干预措施越来越受到关注，凸显了活动记录仪（一种腕戴式加速计测量活动的方法）作为一种告知这些努力的方法。因此，我们对使用活动记录仪测量 ICU 环境中患者活动的研究进行了系统回顾。
我们从建库开始至 2016 年 12 月在 PubMed、EMBASE、CINAHL、Cochrane 图书馆和 ProQuest 进行了检索。
两名审查员独立筛选纳入研究。如果研究发表在同行评议的期刊上并使用活动记录仪测量≥5 名 ICU 患者的活动，则符合纳入标准。
两名审查员独立进行数据提取和偏倚风险评估。提取的基于活动记录仪的活动数据包括总活动时间和活动计数。
共确定了 16 项研究（607 名 ICU 患者），其中 14 项（88%）为观察性研究，2 项（12%）为随机对照试验，5 项（31%）发表于 2009 年之后。每 15 至 60 秒时段的平均日间活动水平为 25 至 37 次，夜间活动水平为 2 至 19 次。在 11 项（69%）和 5 项（31%）研究中，分别在 ICU 和 ICU 后结局的背景下评估了活动记录仪，并且活动记录仪的活动水平与谵妄、镇静、疼痛、焦虑、拔管时间和住院时间之间存在潜在关联。
活动记录仪表明，患者在 ICU 中处于严重不活动状态，基于活动记录仪的活动水平可能与谵妄、镇静和住院时间等重要指标相关。需要更大和更严格的研究来进一步评估这些关联以及活动记录仪在 ICU 环境中的整体效用。
