Department of Health Research Methods, Evidence, and Impact.
Faculty of Health Sciences.
Ann Am Thorac Soc. 2020 Oct;17(10):1289-1307. doi: 10.1513/AnnalsATS.202001-059OC.
Survivors of critical illness may experience physical-function deficits after intensive care unit (ICU) discharge. In-ICU cycle ergometry may facilitate early mobilization and decrease functional impairment. We conducted a systematic review and meta-analysis to understand the effect of in-ICU leg-cycle ergometry on patient-important and clinically relevant outcomes. We searched eight electronic databases from inception until July 2019. We included randomized controlled trials (RCTs) and nonrandomized studies of critically ill adults admitted to the ICU for ≥24 hours, comparing cycling interventions to control arms that did not receive cycling. Main outcomes included physical function, mechanical ventilation (MV) duration, length of stay (LOS), quality of life (QoL), mortality, and safety. We conducted independent duplicate-citation screening, data abstraction, and risk-of-bias assessments. We pooled RCTs using a random-effects model and calculated the risk ratio (RR), mean difference (MD), or standardized MD with 95% confidence intervals (CIs). We assessed certainty of outcomes using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 6,531 citations, we included 12 RCTs and 2 nonrandomized studies ( = 926). Between the cycling and control groups, there were no differences in physical function at hospital discharge (3 RCTs; = 225; standardized MD, 0.07 [95% CI, -0.38 to 0.53]; very low certainty), MV duration (9 RCTs; = 676; MD, 0.01 [-1.04 to 1.07] days; moderate certainty), ICU LOS (10 RCTs; = 511; MD, 0.23 [-1.44 to 1.89] days; moderate certainty), hospital LOS (7 RCTs; = 393, MD -0.07 [-3.87 to 3.73] days; moderate certainty), QoL at 6 months after hospital discharge (2 RCTs; = 103; MD, 9.13 [13.80 to 32.05] points higher; very low certainty), or hospital mortality (7 RCTs; = 710; RR 1.09 [0.82 to 1.46]; moderate-certainty). The adverse event rate in cycling sessions was 0.16% across studies (10 studies; 5 of 3,117 sessions; very low certainty). Cycling initiated in the ICU is probably safe; however, we did not find any differences in physical function, MV duration, LOS, QoL, or mortality compared with those not receiving cycling. Rigorously designed RCTs are needed to improve precision and further investigate the effect of cycling on patient-important outcomes.
危重病幸存者在离开重症监护病房（ICU）后可能会出现身体功能缺陷。ICU 内的循环运动可能有助于早期活动并减少功能障碍。我们进行了系统评价和荟萃分析，以了解 ICU 内腿部循环运动对患者重要和临床相关结果的影响。我们从开始到 2019 年 7 月搜索了八个电子数据库。我们纳入了接受 ICU 治疗≥24 小时的危重症成年人的随机对照试验（RCT）和非随机研究，将循环干预与未接受循环的对照组进行比较。主要结局包括身体功能、机械通气（MV）持续时间、住院时间（LOS）、生活质量（QoL）、死亡率和安全性。我们进行了独立的重复引文筛选、数据提取和偏倚风险评估。我们使用随机效应模型对 RCT 进行了汇总，并计算了风险比（RR）、平均差异（MD）或标准化 MD 及其 95%置信区间（CI）。我们使用推荐评估、制定和评估方法评估了结果的确定性。在 6531 条引文，我们纳入了 12 项 RCT 和 2 项非随机研究（ = 926）。在循环组和对照组之间，出院时的身体功能无差异（3 项 RCT； = 225；标准化 MD，0.07 [95%CI，-0.38 至 0.53]；非常低的确定性）、MV 持续时间（9 项 RCT； = 676；MD，0.01 [-1.04 至 1.07]天；中等确定性）、ICU LOS（10 项 RCT； = 511；MD，0.23 [-1.44 至 1.89]天；中等确定性）、住院 LOS（7 项 RCT； = 393，MD -0.07 [-3.87 至 3.73]天；中等确定性）、出院后 6 个月的 QoL（2 项 RCT； = 103；MD，9.13 [13.80 至 32.05]分更高；非常低的确定性）或医院死亡率（7 项 RCT； = 710；RR 1.09 [0.82 至 1.46]；中等确定性）。研究中循环治疗的不良事件发生率为 0.16%（10 项研究；5/3117 次循环；非常低的确定性）。ICU 内开始循环运动可能是安全的；然而，与未接受循环运动的患者相比，我们没有发现身体功能、MV 持续时间、LOS、QoL 或死亡率有任何差异。需要进行严格设计的 RCT 来提高精确度，并进一步研究循环运动对患者重要结局的影响。
