School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.
School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.
Aust Crit Care. 2024 Nov;37(6):985-993. doi: 10.1016/j.aucc.2024.01.008. Epub 2024 Apr 4.
Intensive care unit (ICU) survivors face functional limitations due to ICU-acquired weakness. Arm cycle ergometry (ACE) introduced in the ICU may improve physical function. To our knowledge, there is limited evidence on the effectiveness of ACE and physical function outcomes in critically ill patients.
The objective of this systematic review was to examine the impact of ICU-based ACE on physical function, safety, and other clinical outcomes.
Systematic Review.
A search of seven databases was conducted from the inception to January 1, 2023: Medline Ahead of Print, Ovid MEDLINE(R), Allied and Complementary Medicine Database (AMED), Embase, Cochrane Central, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).
We included two arm studies of critically ill adults admitted to the ICU who received ACE and any comparator for our primary outcome, physical function. Our secondary outcomes included severe events. We included safety studies with or without a comparator group. Screening, data abstraction, and risk-of-bias assessments were completed independently, in duplicate. We used the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the overall certainty of evidence.
We screened 651 citations and included eight studies that enrolled 183 patients. Due to heterogeneity, meta-analysis was not performed. For our primary outcome, one randomised controlled trial found significant improvements in physical function, measured by the Barthel Index with ACE, whereas a nonrandomised study showed no difference. Out of the six studies reporting safety, none reported any severe safety events. The overall certainty of evidence was very low.
ACE initiated in the ICU is a likely safe intervention. Based on the limited ACE studies and heterogeneity between studies, further research with more rigorous studies evaluating important outcomes for patients is needed.
重症监护病房（ICU）幸存者由于 ICU 获得性虚弱而面临功能限制。在 ICU 中引入的手臂循环测力计（ACE）可能会改善身体功能。据我们所知，关于 ACE 对危重病患者身体功能和其他临床结局的有效性的证据有限。
本系统评价的目的是研究基于 ICU 的 ACE 对身体功能、安全性和其他临床结局的影响。
系统评价。
从成立到 2023 年 1 月 1 日，我们对七个数据库进行了搜索：Medline 提前出版、Ovid MEDLINE（R）、联合和补充医学数据库（AMED）、Embase、Cochrane 中心、物理治疗证据数据库和护理学和联合健康文献累积索引（CINAHL）。
我们纳入了两项关于入住 ICU 的危重病成年人的双臂研究，这些患者接受了 ACE 治疗和任何对照治疗作为我们的主要结局，即身体功能。我们的次要结局包括严重事件。我们纳入了有或没有对照组的安全性研究。筛查、数据提取和偏倚风险评估均独立进行，重复两次。我们使用推荐、评估、开发和评估方法对证据的总体确定性进行评估。
我们筛选了 651 条引文，纳入了八项研究，共纳入了 183 名患者。由于存在异质性，因此未进行荟萃分析。对于我们的主要结局，一项随机对照试验发现 ACE 可显著改善身体功能，使用 Barthel 指数进行评估，而一项非随机研究则显示无差异。在报告安全性的六项研究中，没有一项报告任何严重安全事件。证据的总体确定性非常低。
在 ICU 中启动 ACE 可能是一种安全的干预措施。基于有限的 ACE 研究和研究之间的异质性，需要进行更多严格研究来评估对患者重要结局的研究。
