Liu Keibun, Tronstad Oystein, Flaws Dylan, Churchill Luke, Jones Alice Y M, Nakamura Kensuke, Fraser John F
Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
J Intensive Care. 2024 Feb 29;12(1):11. doi: 10.1186/s40560-024-00724-4.
As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed.
This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions.
PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.
随着重症监护医学的进步不断提高重症监护病房（ICU）的生存率，临床和研究的关注点正迫切转向提高生存质量。重症监护后综合征（PICS）是一组复杂的身体、认知和精神功能障碍，严重影响患者出院后的生活。本综述全面且多维度地总结了目前在ICU住院期间及出院后进行运动疗法（ET）以预防和管理PICS各个方面的证据和实践。该综述旨在阐明ET在ICU康复中的作用机制和效果的证据，并强调ICU患者欠佳的临床和功能结局是一个日益严重的公共卫生问题，亟待解决。
本综述首先简要概述了当前PICS与ET之间的关系，介绍了关于该主题的最新研究。随后总结了ET在ICU、医院病房及出院后的应用情况，阐明了这些环境之间存在问题的过渡阶段。接下来的章节聚焦于ET对身体、认知和精神功能的影响，详细阐述了功能障碍的多方面生物学和病理生理机制以及ET在这三个方面的益处。随后是一章关于联合干预以及如何最大化和增强ET效果的内容，概述了优化ET有效性的实用策略。综述接着描述了几种已引入/建议用于在ICU住院期间及出院后增强和支持ET实施的新兴技术。最后，综述讨论了未来的研究方向。
PICS是一个日益受到全球医疗关注的问题。本综述旨在指导临床医生、研究人员、政策制定者和医疗服务提供者将ET用作ICU住院期间及出院后患者的治疗和预防措施，以解决这一问题。更好地理解ET的有效性以及亟待解决的临床和研究差距，将极大地帮助临床医生努力使ICU幸存者康复，提高患者的生存质量，并帮助他们出院后回归正常生活。
