University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; Bloomsbury Institute for Intensive Care Medicine, University College London, Cruciform Building, Gower Street, London WC1E 6BT, UK.
Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
Physiotherapy. 2020 Jun;107:169-175. doi: 10.1016/j.physio.2019.06.008. Epub 2019 Jul 2.
Early rehabilitation is assumed to be a crucial intervention to facilitate weaning from mechanical ventilation in critically ill patients and to limit their long-term functional dependence. However, little is known about the physiological load imposed on patients during such interventions. Without the ability to quantify the exercise intensity of rehabilitation interventions it is impossible to establish a clear separation between usual care and intervention groups in randomised controlled trials. This may explain the lack of definitive benefit of rehabilitation in published trials. We sought to characterise the physiological load, measured as oxygen consumption (V˙O), of the physical activities carried out during rehabilitation interventions in mechanically ventilated participants.
Observational study.
Single centre medical-surgical university hospital ICU.
26 mechanically ventilated participants ventilated >7 days, able to participate in a rehabilitation program.
Oxygen consumption (measured by the Medgraphics Ultima breath-by-breath gas exchange analysis system) and heart rate were measured continuously pre-, during and post-standard rehabilitation sessions.
52 sessions were recorded in 26 participants. There was considerable variation in the oxygen cost of the physical activities between participants. The recovery time for 1 in 4 rehabilitation sessions was longer than the rehabilitation activity time.
Absolute exercise intensity in mechanically ventilated ICU participants, as measured by oxygen consumption, is not activity-dependent.
早期康复被认为是促进危重症患者脱机和限制其长期功能依赖的关键干预措施。然而，对于此类干预措施对患者造成的生理负荷知之甚少。如果无法量化康复干预的运动强度，就不可能在随机对照试验中将常规护理和干预组明确区分开来。这可能解释了发表的试验中康复没有明确益处的原因。我们旨在描述机械通气患者在康复干预期间进行的体力活动的生理负荷，以耗氧量（V˙O）来衡量。
观察性研究。
单中心内科-外科大学医院 ICU。
26 名机械通气>7 天、能够参与康复计划的参与者。
通过 Medgraphics Ultima 逐口气体交换分析系统连续测量氧耗量（通过测量得出）和心率，在标准康复疗程前、期间和之后进行测量。
在 26 名参与者中记录了 52 个疗程。参与者之间体力活动的耗氧量差异很大。四分之一的康复疗程的恢复期比康复活动时间长。
通过氧耗量衡量，机械通气 ICU 参与者的绝对运动强度与活动无关。
