Bach Christina, Hetland Breanna
Christina Bach is a PhD student and research assistant at the University of Nebraska Medical Center College of Nursing and a staff nurse and relief lead in the oncology intensive care unit at Nebraska Medicine in Omaha, Nebraska.
Breanna Hetland is an assistant professor at the University of Nebraska Medical Center College of Nursing and a critical nurse scientist at Nebraska Medicine in Omaha.
Crit Care Nurse. 2022 Dec 1;42(6):13-24. doi: 10.4037/ccn2022459.
Critical illness survivors have impairments across physical, psychological, and cognitive health domains known as post-intensive care syndrome. Although physical activity can improve outcomes across all health domains, most intensive care unit early mobility studies focus solely on physical outcomes.
To explore the role of early mobility for adult patients in the intensive care unit by analyzing early mobility intervention studies with physical, psychological, or cognitive outcome measures.
This integrative review used Whittemore and Knafl's methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched for primary research articles published from 2005 through 2021 on adult intensive care unit early mobility interventions evaluated by physical, cognitive, or psychological outcome measures during or after intervention delivery. Interventions comprising only passive mobility were excluded.
Of 1009 articles screened, 20 were included. Variations in outcome measures, measurement timing, instruments, and control groups made synthesis difficult. No study evaluated an intervention using outcome measures from all 3 health domains. Five studies measured physical and cognitive outcomes; 6 studies measured physical and psychological outcomes.
Early mobility is primarily addressed objectively and unidimensionally, limiting understanding of the implications of early mobility for patients. Post-intensive care syndrome prevention begins in the intensive care unit; early mobility is a promising intervention for targeting multiple risk factors. Studies that measure outcomes in all health domains during or after early mobility are needed to better evaluate the comprehensive effects of early mobility.
危重症幸存者在身体、心理和认知健康领域存在功能障碍，即所谓的重症监护后综合征。尽管体育活动可以改善所有健康领域的预后，但大多数重症监护病房早期活动研究仅关注身体方面的预后。
通过分析采用身体、心理或认知预后指标的早期活动干预研究，探讨早期活动对重症监护病房成年患者的作用。
本整合性综述采用了惠特莫尔和克纳夫的方法以及系统评价与Meta分析的首选报告项目指南。检索了CINAHL、Embase、PubMed、PsycINFO和Scopus数据库，以查找2005年至2021年发表的关于成年重症监护病房早期活动干预的原始研究文章，这些干预在实施期间或之后通过身体、认知或心理预后指标进行评估。仅包括被动活动的干预被排除。
在筛选的1009篇文章中，纳入了20篇。预后指标、测量时间、工具和对照组的差异使得综合分析变得困难。没有研究使用来自所有三个健康领域的预后指标来评估一项干预措施。五项研究测量了身体和认知预后；六项研究测量了身体和心理预后。
早期活动主要从客观和单一维度进行探讨，限制了对早期活动对患者影响的理解。重症监护后综合征的预防始于重症监护病房；早期活动是针对多种风险因素的一种有前景的干预措施。需要开展在早期活动期间或之后测量所有健康领域预后的研究，以更好地评估早期活动的综合效果。
