Post Anaesthetic Critical Care Unit, Tallaght University Hospital, Dublin, Ireland.
The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
Nurs Crit Care. 2023 Jul;28(4):499-509. doi: 10.1111/nicc.12785. Epub 2022 Jun 1.
EM has been hypothesized to help prevent the development of ICU acquired weakness and may therefore result in positive outcomes for ICU patients.
To establish the impact of Early mobilisation (EM) on adult Intensive Care Unit (ICU) patients in terms of ICU length of stay (LOS), as well as hospital LOS, duration of mechanical ventilation, mortality, and functional independence.
A Systematic Review. EMBASE, MEDLINE, CINAHL, and the Cochrane Library were searched on 24th November 2020. Included studies and other systematic reviews were hand-searched for further includable studies. The primary outcome was ICU LOS whilst secondary outcomes were duration of MV, mortality, hospital LOS and functional independence. The PRISMA guidelines were utilized to perform the review. Ten randomized controlled trials with a combined total of 1291 patients met inclusion criteria and were scrutinized using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews. Revman 5.4.1 was used to conduct meta-analysis were possible.
Results were limited by the evidence available for inclusion, in particular small sample sizes. However, a trend towards a shorter duration of ICU LOS and duration of mechanical ventilation emerged. There was also a trend towards higher rates of functional independence for intervention groups. Mortality rates appeared unaffected and results of meta-analysis were statistically non-significant (p = 0.90).
By applying a stricter time limit than previous systematic reviews a trend emerged that the commencement of EM has a positive effect on patient outcomes, in particular ICU LOS.
The evidence base surrounding EM remains poor; however on the balance of the available evidence the application of EM should not be delayed.
早期活动（EM）被假设可以帮助预防 ICU 获得性肌无力的发生，因此可能对 ICU 患者产生积极的结果。
确定早期活动（EM）对成年 ICU 患者的影响，包括 ICU 住院时间（LOS）、住院 LOS、机械通气时间、死亡率和功能独立性。
系统评价。于 2020 年 11 月 24 日在 EMBASE、MEDLINE、CINAHL 和 Cochrane 图书馆进行了系统检索。纳入的研究和其他系统评价也进行了手工检索，以寻找更多可纳入的研究。主要结局是 ICU LOS，次要结局是机械通气时间、死亡率、住院 LOS 和功能独立性。采用 PRISMA 指南进行综述。纳入了 10 项随机对照试验，共 1291 名患者，使用 Joanna Briggs 研究所（JBI）系统评价清单进行了评估。如果可能，使用 Revman 5.4.1 进行荟萃分析。
由于纳入的证据有限，特别是样本量较小，结果受到限制。然而，ICU LOS 和机械通气时间的缩短趋势出现了。干预组的功能独立性率也有上升的趋势。死亡率似乎没有受到影响，荟萃分析的结果在统计学上无显著性（p=0.90）。
通过应用比以前的系统评价更严格的时间限制，出现了一种趋势，即早期活动的开始对患者的结局，特别是 ICU LOS 有积极的影响。
围绕 EM 的证据基础仍然薄弱；然而，在现有证据的基础上，EM 的应用不应被推迟。
