心脏周期：心脏手术后重症患者床上骑行的初步可行性研究。
CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery.
作者信息
Newman Anastasia N L, Kho Michelle E, Harris Jocelyn E, Zamir Nasim, McDonald Ellen, Fox-Robichaud Alison, Solomon Patricia
机构信息
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Hamilton General Hospital, Hamilton, Ontario, Canada.
出版信息
Pilot Feasibility Stud. 2021 Jan 7;7(1):13. doi: 10.1186/s40814-020-00760-5.
BACKGROUND
In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients.
METHODS
We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events.
RESULTS
We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4).
CONCLUSIONS
In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample.
TRIAL REGISTRATION
This trial was registered with Clinicaltrials.gov ( NCT02976415 ). Registered November 29, 2016.
背景
床上骑行是重症监护病房早期活动启动的一种新方式。尚无研究调查其在心脏手术后恢复不佳的重症患者中的应用情况。在进行有效性试验之前，需要可行性数据。本研究的目的是确定床上骑行在心脏手术恢复不佳患者群体中的可行性。
方法
我们在加拿大安大略省一家拥有16张床位的成人心脏手术重症监护病房进行了一项前瞻性可行性研究。既往能够自主活动的成年人（≥18岁），术后机械通气≥72小时，在心脏手术后3至7天内入组。由重症监护病房的物理治疗师每周5天为患者提供20分钟的床上骑行。主要结局指标为可行性，即骑行适宜时患者骑行疗程的百分比。次要结局指标为骑行安全性，以因预先确定的不良事件而停止骑行来衡量。
结果
我们筛查了2074例患者，29例符合纳入标准，23例（92%）同意参与。患者以男性为主（78.26%），年龄中位数[四分位间距]为76[11]岁，接受单纯冠状动脉搭桥手术（39.1%），欧洲心脏手术风险评估系统II（EuroScore II）中位数为5.4[7.8]。术后开始骑行的平均（标准差）时间为5.9（1.4）天。在符合条件的日子里，80.5%（136/169）的患者进行了骑行，因物理治疗人员配备有限导致48.5%的患者骑行疗程缺失。在136次骑行疗程中，3例患者发生了3起不良事件。不良事件发生率为每100个患者骑行疗程2.2起（95%可信区间0.50，6.4）。
结论
在有足够物理治疗人员配备的情况下，对重症心脏手术患者进行床上骑行是可行的，且似乎是安全的。需要进一步的研究来确定该干预措施在更大样本中的有效性。
试验注册
本试验已在Clinicaltrials.gov注册（NCT02976415）。于2016年11月29日注册。
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