Mayer Kirby P, Pastva Amy M, Du Gaixin, Hatchett Sarah P, Chang Mingguang, Henning Angela N, Maher Baz, Morris Peter E, Zwischenberger Joseph B
Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA.
Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Phys Ther. 2022 Mar 1;102(3). doi: 10.1093/ptj/pzab301.
The aims of this study were to determine whether physical rehabilitation intervention for individuals who required extracorporeal membrane oxygenation (ECMO) is associated with clinical outcomes and to assess whether the patient mobility response over initial rehabilitation sessions early in the intensive care unit (ICU) course predicts or is associated with survival, lengths of stay, discharge disposition, and 30-day readmissions.
This study was a 10-year retrospective practice analysis of adults who were critically ill and required ECMO for >72 hours in the cardiothoracic ICU at an academic medical center. Physical rehabilitation implemented during or following the initiation of ECMO was quantified on the basis of timing, frequency, and change in mobility level in response to the intervention over the first 4 consecutive sessions. The primary dependent outcome was in-hospital mortality. Secondary outcomes included 30-day readmission and discharge disposition ranked on an ordinal scale.
Three hundred fifteen individuals (mean age = 50 years [SD = 15 years]; 63% men; mean Sequential Organ Failure Assessment score = 11.6 [SD = 3.3]) met the inclusion criteria. Two hundred eighteen individuals (69%) received at least 1 physical rehabilitation session while requiring ECMO, 70 (22%) received rehabilitation after ECMO was discontinued, and 27 (9%) never received rehabilitation. Individuals discharged alive achieved higher mobility levels and had a steeper, more positive rate of change in mobility over the first 4 sessions than individuals who died in the hospital (2.8 vs 0.38; degrees of freedom = 199, t = 8.24). Those who received rehabilitation and achieved the milestones of sitting on the edge of the bed and walking for >45 m were more likely to survive (47% vs 13%; χ2 = 156) than those who did not (26% vs 3.5%; χ2 = 80).
A positive rate of change in mobility and the ability to achieve mobility milestones with rehabilitation were associated with improved clinical outcomes.
An individual's mobility response to physical rehabilitation early in the ICU course is an important indicator of illness and should be used with clinical presentation to guide clinical decision-making and predict outcomes.
本研究旨在确定对需要体外膜肺氧合（ECMO）的个体进行物理康复干预是否与临床结局相关，并评估在重症监护病房（ICU）病程早期的初始康复疗程中患者的活动能力反应是否可预测或与生存率、住院时间、出院处置及30天再入院率相关。
本研究是一项对在一所学术医疗中心心胸外科ICU中病情严重且需要ECMO超过72小时的成年人进行的为期10年的回顾性实践分析。根据启动ECMO期间或之后进行的物理康复的时间、频率以及在连续前4个疗程中对干预的活动水平变化进行量化。主要的相关结局是院内死亡率。次要结局包括30天再入院率和按序数量表分级的出院处置。
315名个体（平均年龄 = 50岁[标准差 = 15岁]；63%为男性；平均序贯器官衰竭评估评分 = 11.6[标准差 = 3.3]）符合纳入标准。218名个体（69%）在需要ECMO时接受了至少1次物理康复疗程，70名（22%）在ECMO停止后接受了康复治疗，27名（9%）从未接受过康复治疗。存活出院的个体在最初4个疗程中的活动水平更高，且活动能力变化率更陡、更积极，高于在医院死亡的个体（2.8对0.38；自由度 = 199，t = 8.24）。与未达到这些里程碑的个体（26%对3.5%；χ2 = 80）相比，接受康复治疗并达到坐在床边和行走超过45米里程碑的个体存活的可能性更大（47%对13%；χ2 = 156）。
活动能力的积极变化率以及通过康复达到活动能力里程碑的能力与改善的临床结局相关。
个体在ICU病程早期对物理康复的活动能力反应是疾病的一个重要指标，应结合临床表现用于指导临床决策和预测结局。
