Mayer Kirby P, Hornsby Amanda R, Soriano Victor Ortiz, Lin Timothy C, Cunningham Jennifer T, Yuan Hanwen, Hauschild Caroline E, Morris Peter E, Neyra Javier A
Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA.
Inpatient Rehabilitation Department, Chandler Medical Center, University of Kentucky, Lexington, Kentucky, USA.
Kidney Int Rep. 2019 Oct 11;5(1):39-47. doi: 10.1016/j.ekir.2019.10.003. eCollection 2020 Jan.
Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT.
Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse events such as transient oxygen desaturation >10% of resting. Limited efficacy testing was performed to determine if rehabilitation parameters were associated with clinical outcomes.
A total of 67 patients (54.0 ± 15.6 years old, 44% women, body mass index 29.2 ± 9.3 kg/m) received early rehabilitation under this protocol. The median days of CRRT were 6.0 (interquartile range [IQR], 2-11) and 72% of patients were on mechanical ventilation concomitantly with CRRT at the time of rehabilitation. A total of 112 rehabilitation sessions were performed of 152 attempts (74% completion rate). No major adverse events occurred. Patients achieving higher levels of mobility were more likely to be alive at discharge ( = 0.076).
The provision of early rehabilitation in critically ill patients requiring CRRT is safe and feasible. Further, these preliminary results suggest that early rehabilitation with focus on mobility may improve patient outcomes in this susceptible population.
危重症患者的早期康复与改善预后相关。近期研究表明，需要持续肾脏替代治疗（CRRT）的患者能够安全地进行活动。本研究的目的是评估以活动为重点的早期康复在需要CRRT的患者中的安全性和可行性。
研究设计为对质量改进方案的混合方法分析。研究地点是一家三级医疗中心的重症监护病房（ICU）。通过记录主要不良事件的发生率来前瞻性评估安全性，主要不良事件包括CRRT导管移位、意外拔管、出血和血流动力学紧急情况；以及轻微不良事件，如静息时短暂氧饱和度下降>10%。进行了有限的疗效测试以确定康复参数是否与临床结果相关。
共有67例患者（年龄54.0±15.6岁，44%为女性，体重指数29.2±9.3kg/m）按照该方案接受了早期康复治疗。CRRT的中位天数为6.0天（四分位间距[IQR]，2-11），72%的患者在康复时同时接受CRRT和机械通气。在152次尝试中总共进行了112次康复治疗（完成率74%）。未发生重大不良事件。活动水平较高的患者出院时存活的可能性更大（P=0.076）。
为需要CRRT的危重症患者提供早期康复是安全可行的。此外，这些初步结果表明，以活动为重点的早期康复可能改善这一易感人群的患者预后。
