Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Apr 20;35(15):e101. doi: 10.3346/jkms.2020.35.e101.
Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes.
A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit.
During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not ( < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65-0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy ( < 0.001; HR, 0.83; 95% CI, 0.77-0.88).
In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.
尽管危重症患者的康复治疗越来越重要，但关于康复治疗在临床实践中的应用情况的信息却很少。我们的目的是评估重症监护病房（ICU）幸存者中康复治疗的实施率，并研究康复治疗对结局的影响。
这是一项回顾性的全国性队列研究，纳入了 2008 年 1 月至 2015 年 5 月期间入住 ICU 的年龄＞18 岁的患者（n=1465776）。分析的结局包括 ICU 再入院和急诊室（ER）就诊。
在研究期间，249918 例（17.1%）患者接受了康复治疗。接受任何康复治疗的患者比例逐年增加，从 2008 年的 14%增加到 2014 年的 20%，每种治疗方式的比例也随着时间的推移而增加。最常见的康复治疗是物理疗法（91.9%），其次是神经肌肉电刺激（29.6%）、职业（28.6%）、呼吸（11.6%）和吞咽（10.3%）治疗。在调整混杂因素后，与未接受康复治疗的患者相比，接受康复治疗的患者 30 天内 ICU 再入院的风险较低（<0.001；危险比[HR]，0.70；95%置信区间[CI]，0.65-0.75）。此外，接受康复治疗的患者 30 天内 ER 就诊的风险也较低（<0.001；HR，0.83；95%CI，0.77-0.88）。
在这项韩国全国性队列研究中，只有 17%的 ICU 患者接受了康复治疗。然而，康复治疗与 30 天内 ICU 再入院和 ER 就诊风险的显著降低相关。
