University Hospital Schleswig-Holstein, Campus Kiel, Brunswiker Str. 10, Kiel 24105, Germany.
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
Intensive Crit Care Nurs. 2023 Feb;74:103334. doi: 10.1016/j.iccn.2022.103334. Epub 2022 Oct 27.
Does early mobilisation as standalone or part of a bundle intervention, compared to usual care, prevent and/or shorten delirium in adult patients in Intensive Care Units?
Early mobilisation is recommended for the prevention and treatment of delirium in critically ill patients, but the evidence remains inconclusive.
Systematic literature search in Pubmed, CINAHL, PEDRo, Cochrane from inception to March 2022, and hand search in previous meta-analysis. Included were randomized trials or quality-improvement projects. meta-analysis was performed for Odds Ratios or mean differences including 95% Confidence Intervals for presence/duration of delirium. Risk of bias was assessed by using Joanna Briggs Quality criteria. meta-regression was performed to analyse heterogeneity.
The search led to 13 studies of low-moderate risk of bias including 2,164 patients. Early mobilisation reduced the risk of delirium by 47 % (13 studies, 2,164 patients, low to moderate risk of bias: Odds Ratio 0.53 (95 % Confidence Interval 0.34 till 0.83, p = 0.01), with significant heterogeneity (I = 78 %, p < 0.001). Early mobilisation also reduced the duration of delirium by 1.8 days (3 studies, 296 patients, low-moderate risk of bias: Mean difference -1.78 days (95 % Confidence Interval -2.73 till -0.83 days, p < 0.001), heterogeneity 0 % (p = 0.41). Other analyses such as low risk of bias studies, randomised trials, studies published ≥ 2017, high intensity, and mobilisation as stand-alone intervention showed no significant results, with conflicting certainty of evidence and high heterogeneity. meta-regression could not explain heterogeneity.
There is an uncertain effect of mobilisation on delirium. Provision of early mobilisation to critical ill patients might prevent delirium. There is a possible effect of early mobilisation to shorten the duration of delirium. Due to the heterogeneity in the findings, further research to define the best method and dosage of early rehabilitation is required.
与常规护理相比，早期活动作为独立干预或干预措施的一部分，是否可以预防和/或缩短重症监护病房成人患者的谵妄？
早期活动被推荐用于预防和治疗危重病患者的谵妄，但证据仍不确定。
系统检索 Pubmed、CINAHL、PEDRo、Cochrane 从成立到 2022 年 3 月的文献，并在手头的荟萃分析中进行了手工检索。纳入的研究为随机试验或质量改进项目。对于存在/谵妄持续时间的比值比或均数差异，进行荟萃分析，包括 95%置信区间。使用 Joanna Briggs 质量标准评估偏倚风险。进行荟萃回归分析以分析异质性。
搜索结果导致 13 项低到中度偏倚风险的研究，包括 2164 名患者。早期活动使谵妄的风险降低了 47%（13 项研究，2164 名患者，低到中度偏倚风险：比值比 0.53（95%置信区间 0.34 至 0.83，p=0.01），异质性显著（I=78%，p<0.001）。早期活动还使谵妄的持续时间缩短了 1.8 天（3 项研究，296 名患者，低到中度偏倚风险：平均差异-1.78 天（95%置信区间-2.73 至-0.83 天，p<0.001），异质性为 0%（p=0.41）。其他分析，如低偏倚风险研究、随机试验、发表于 2017 年及以后的研究、高强度、独立活动，均未显示出显著结果，证据确定性存在冲突，异质性高。荟萃回归无法解释异质性。
早期活动对谵妄的影响不确定。为重症患者提供早期活动可能会预防谵妄。早期活动可能会缩短谵妄的持续时间。由于研究结果存在异质性，需要进一步研究以确定最佳的早期康复方法和剂量。
