Jiroutková Kateřina, Duška František, Waldauf Petr
All authors: Department of Anaesthesia and Intensive Care, Charles University, 3rd Faculty of Medicine and FNKV University Hospital, Prague, Czech Republic.
Crit Care Med. 2024 Mar 19. doi: 10.1097/CCM.0000000000006259.
We published a meta-analysis in March 2020 to assess the impact of rehabilitation in the ICU on clinical outcomes. Since then, 15 new randomized controlled trials (RCTs) have been published; we updated the meta-analysis to show how the recent studies have tipped the scale.
Systematic review and meta-analysis.
An update of secondary data analysis of RCTs published between January 1998 and July 2023 performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Critically ill adults.
Cycling exercises or neuromuscular electrical stimulation (NMES) or protocolized physical rehabilitation (PPR) or functional electrical stimulation-assisted cycle ergometry (FESCE) compared with standard of care.
Days on a mechanical ventilator, length of stay in ICU and at the hospital, and mortality. We found 15 RCTs (one on cycling, eight on NMES alone, four on PPR, and two on FESCE) into which 2116 patients were randomized. The updated meta-analysis encompasses a total of 5664 patients. The exercise interventions did not influence mortality (odds ratio, 1.00 [0.87-1.14]; n = 53 RCTs) but reduced the duration of mechanical ventilation (mean difference, -1.76 d [-2.8 to -0.8 d]; n = 46) and length of stay in ICU (-1.16 d [-2.3 to 0.0 d]; n = 45). The effects on the length of mechanical ventilation and ICU stay were only significant for the PPR subgroup by a median of -1.7 days (95% CI, -3.2 to -0.2 d) and -1.9 days (95% CI, -3.5 to -0.2 d), respectively. Notably, newly published trials provided consistent results and reduced the overall heterogeneity of these results.
None of the rehabilitation intervention strategies being studied influence mortality. Both mechanical ventilation and ICU stay were shortened by PPR, this strengthens the earlier findings as all new RCTs yielded very consistent results. However, no early rehabilitation interventions in passive patients seem to have clinical benefits. Regarding long-term functional outcomes, the results remain inconclusive.
我们于2020年3月发表了一项荟萃分析，以评估重症监护病房（ICU）中的康复治疗对临床结局的影响。自那时以来，又发表了15项新的随机对照试验（RCT）；我们更新了荟萃分析，以展示近期研究是如何改变局面的。
系统评价和荟萃分析。
对1998年1月至2023年7月期间发表的RCT的二次数据分析进行更新，按照系统评价和荟萃分析的首选报告项目指南进行。
重症成年患者。
将骑行运动、神经肌肉电刺激（NMES）、规范化物理康复（PPR）或功能性电刺激辅助自行车测力计运动（FESCE）与标准治疗进行比较。
机械通气天数、在ICU和医院的住院时间以及死亡率。我们找到了15项RCT（1项关于骑行运动，8项仅关于NMES，4项关于PPR，2项关于FESCE），共有2116例患者被随机分组。更新后的荟萃分析共纳入5664例患者。运动干预不影响死亡率（优势比，1.00[0.87 - 1.14]；n = 53项RCT），但缩短了机械通气时间（平均差，-1.76天[-2.8至-0.8天]；n = 46）和在ICU的住院时间（-1.16天[-2.3至0.0天]；n = 45）。对机械通气时间和ICU住院时间的影响仅在PPR亚组中显著，中位数分别为-1.7天（95%CI，-3.2至-0.2天）和-1.9天（95%CI，-3.5至-0.2天）。值得注意的是，新发表的试验提供了一致的结果，并降低了这些结果的总体异质性。
所研究的康复干预策略均不影响死亡率。PPR缩短了机械通气时间和在ICU的住院时间，这强化了早期的研究结果，因为所有新的RCT都得出了非常一致的结果。然而，对于被动患者而言，早期康复干预似乎没有临床益处。关于长期功能结局，结果仍无定论。
