Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China.
Office of Program Design and Statistics, West China Hospital, Sichuan University, Chengdu, China.
Nurs Crit Care. 2023 Jul;28(4):510-518. doi: 10.1111/nicc.12896. Epub 2023 Mar 16.
The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China.
To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors.
A cross-sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM.
In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff-to-bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well-established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs.
Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains.
To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards.
中国大陆的早期康复领域发展缓慢，关于中国重症监护病房（ICU）早期活动实施情况的数据有限。
调查中国大陆 ICU 中早期活动的实施情况，并分析其影响因素。
采用横断面电子调查的方法，对中国 11 个省的 444 家 ICU 进行调查。护士长提供了机构特征和 ICU 中早期活动实施情况的数据。采用逻辑回归模型确定与早期活动实施相关的因素。
共 56.98%（253/444）的 ICU 实施了早期活动，其中 86 家 ICU 实施了全面或完整的早期活动。在未实施早期活动的 191 家 ICU 中，有 136 家计划在近期实施早期活动。在实施早期活动的 253 家 ICU 中，21.34%的 ICU 对所有符合条件的患者实施了早期活动，24.90%的 ICU 在 ICU 入住后 48 h 内评估并实施早期活动，39.13%的 ICU 有协作性早期活动团队，34.39%的 ICU 使用了早期活动方案，14.63%的 ICU 开展了多学科查房，17.39%的 ICU 对所有早期活动有医嘱和收费标准。仅有 18.18%的 ICU 对早期活动进行了频繁的专业培训，在实施早期活动的 ICU 中，有 15.41%发生了异常事件。多变量逻辑回归分析显示，经济实力较强的省份、有专门治疗师团队、较多的 ICU 床位和较高的床护比有利于早期活动的实施。此外，多学科查房、建立良好的医嘱和收费标准、高频次的专业培训，均可以促进 ICU 中早期活动的全面推广和发展。
危重症患者的早期活动实施率和质量均有待提高。中国的 ICU 早期活动仍处于起步阶段，需要多方面的发展。
为促进 ICU 中早期活动的实施，应部署更多的人力资源，特别是专业治疗师团队的参与。此外，卫生保健提供者应积极组织多学科查房和专业培训，并制定适当的早期活动医嘱和收费标准。
