The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Respir Care. 2021 Feb;66(2):307-315. doi: 10.4187/respcare.07888. Epub 2020 Sep 8.
Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle is ensuring patient safety. Comprehensively assessing the physical condition of patients considered for mobilization is the basis of safety. However, appropriate guidance is lacking. We performed a systematic review to extract and summarize current safety assessment criteria for the early active mobilization of mechanically ventilated patients in the ICU.
A systematic literature search was conducted using English and Chinese databases according to the PRISMA checklist and guidelines to identify relevant original studies that evaluated safety assessment variables and specific parameters.
A total of 24 medium- and high-quality articles involving a total of 4,842 subjects were included in the analysis. Among these studies, there were 15 randomized controlled trials involving 1,777 subjects (888 in the control groups, 889 in the interventional groups) and 9 cohort studies involving 3,065 subjects (1,240 in the control groups, 1,825 in the exposure groups). There were 5 safety assessment criteria, including cardiovascular, respiratory, neurological, musculoskeletal, and other. Within these were 17 different variables and 48 specific parameters.
The safety assessment criteria should focus on cardiac reserve, respiratory reserve, consciousness, and muscle strength. It is especially important to note whether the parameters are stable because parameter stability can be more representative of a patient's condition than absolute values. We provide a flow diagram for clinical safety assessments; however, some limitations exist, and this assessment requires further validation and optimization.
尽管研究已经证实早期积极活动的安全性和可行性，但其实践状况仍不尽人意。最重要的障碍是确保患者安全。全面评估考虑活动的患者的身体状况是安全的基础。然而，目前缺乏适当的指导。我们进行了一项系统评价，以提取和总结目前 ICU 机械通气患者早期积极活动的安全性评估标准。
根据 PRISMA 清单和指南，使用英文和中文数据库进行系统文献检索，以确定评估安全性评估变量和具体参数的相关原始研究。
共纳入 24 篇中高质量文章，共涉及 4842 例患者。其中，有 15 项随机对照试验，共 1777 例患者（对照组 888 例，干预组 889 例）和 9 项队列研究，共 3065 例患者（对照组 1240 例，暴露组 1825 例）。有 5 个安全性评估标准，包括心血管、呼吸、神经、肌肉骨骼和其他。在这些标准中，有 17 个不同的变量和 48 个具体参数。
安全性评估标准应重点关注心脏储备、呼吸储备、意识和肌肉力量。需要特别注意参数是否稳定，因为参数稳定性比绝对值更能代表患者的情况。我们提供了临床安全性评估的流程图；然而，存在一些局限性，并且此评估需要进一步验证和优化。
