Zhang Chuanlin, Wang Xueqin, Mi Jie, Zhang Zeju, Luo Xinyi, Gan Ruiying, Mu Shaoyu
Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
School of Nursing, Chongqing Medical University, Chongqing, China.
Crit Care Res Pract. 2024 Mar 22;2024:4118896. doi: 10.1155/2024/4118896. eCollection 2024.
Intensive care unit (ICU)-acquired weakness often occurs in patients with invasive mechanical ventilation (IMV). Early active mobility may reduce ICU-acquired weakness, improve functional status, and reduce disability. The aim of this study was to investigate whether high-intensity early mobility improves post-ICU discharge functional status of IMV patients.
132 adult patients in the ICU who were undergoing IMV were randomly assigned into two groups with a ratio of 1 : 1, with one group received high-intensity early mobility (intervention group, IG), while the other group received conventional treatment (control group, CG). The functional status (Barthel Index (BI)), capacity of mobility (Perme score and ICU Mobility Scale (IMS)), muscle strength (Medical Research Council sum scores (MRC-SS)), mortality, complication, length of ICU stay, and duration of IMV were evaluated at ICU discharge or after 3-month of ICU discharge.
The patient's functional status was improved (BI scores 90.6 ± 18.0 in IG vs. 77.7 ± 27.9 in CG; =0.005), and capacity of mobility was increased (Perme score 17.6 ± 7.1 in IG vs. 12.2 ± 8.5 in CG, < 0.001; IMS 4.7 ± 2.6 in IG vs. 3.0 ± 2.6 in CG, < 0.001). The IG had a higher muscle strength and lower incidence of ICU-acquired weakness (ICUAW) than that in the CG. The incidence of mortality and delirium was also lower than CG at ICU discharge. However, there were no differences in terms of length of ICU stay, duration of IMV, ventilator-associated pneumonia, and venous thrombosis.
High-intensity early mobility improved the patient's functional status and increased capacity of mobility with IMV. The benefits to functional status remained after 3 month of ICU discharge. Other benefits included higher muscle strength, lower incidence of ICUAW, mortality, and delirium in IG.
重症监护病房（ICU）获得性肌无力常见于有创机械通气（IMV）患者。早期主动活动可能会减轻ICU获得性肌无力，改善功能状态，并减少残疾。本研究旨在调查高强度早期活动是否能改善IMV患者ICU出院后的功能状态。
132例在ICU接受IMV的成年患者按1∶1比例随机分为两组，一组接受高强度早期活动（干预组，IG）；另一组接受常规治疗（对照组，CG）。在ICU出院时或ICU出院3个月后评估功能状态（Barthel指数（BI））、活动能力（Perme评分和ICU活动量表（IMS））、肌肉力量（医学研究委员会总分（MRC-SS））、死亡率、并发症、ICU住院时间及IMV持续时间。
患者功能状态得到改善（干预组BI评分为90.6±18.0，对照组为77.7±27.9；P=0.005），活动能力增强（干预组Perme评分为17.6±7.1，对照组为12.2±8.5，P<0.001；干预组IMS为4.7±2.6，对照组为3.0±2.6，P<0.001）。干预组肌肉力量更强，ICU获得性肌无力（ICUAW）发生率低于对照组。在ICU出院时，干预组的死亡率和谵妄发生率也低于对照组。然而，在ICU住院时间、IMV持续时间、呼吸机相关性肺炎及静脉血栓形成方面无差异。
高强度早期活动改善了IMV患者的功能状态，增强了活动能力。在ICU出院3个月后，对功能状态的益处依然存在。其他益处包括干预组肌肉力量更强、ICUAW发生率更低、死亡率及谵妄发生率更低。
