Sun Ruixiang, Jiang Haijiao, Wang Jun, Yu Jintian, Zhou Quan, Fang Ke, Ci Caizhe
Anhui Respiratory Critical Care Emergency Center, Department of Critical Care Medicine, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui, China.
Department of Cardiovascular Medicine, the Third Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China. Corresponding author: Ci Caizhe, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Jul;36(7):745-752. doi: 10.3760/cma.j.cn121430-20240227-00169.
To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.
A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.
A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.
The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.
采用循证方法整合机械通气的重症监护病房获得性肌无力（ICU-AW）患者早期康复的最佳证据，为机械通气的ICU-AW患者早期运动治疗的标准化评估和干预提供循证依据。
对美国胸科学会（ATS）临床实践指南、安大略注册护士协会（RNAO）、指南国际网络（GIN）、加拿大医学协会临床实践指南库（CMACPGL）、BMJ临床证据、UpToDate、苏格兰校际指南网络（SIGN）、PubMed、Cochrane图书馆、国家指南交换中心（NGC）、Embase、护理及相关健康文献累积索引（CINAHL）、UM图书馆数据库、物理治疗证据数据库（PEDro）、英国国家卫生与临床优化研究所（NICE）、新西兰指南小组（NZGG）、中国医学脉动指南网站、中国知网和万方数据等中英文数据库、专业团队网站及指南网站进行系统检索，获取关于机械通气的ICU-AW患者早期运动康复的专家共识、指南、随机对照试验（RCT）、系统评价等证据。检索时限为各数据库建库至2023年12月31日。由两名评价员独立进行文献检索、筛选、评价、信息提取并交叉核对，同时对纳入文献进行质量评价。
共纳入21篇文献，其中指南5篇, 系统评价5篇, 专家共识4篇, RCT 7篇，均为高证据级别文献，全部纳入。将其归纳为以评估筛选、运动安全标准、注意事项、运动时间设定、运动强度、运动顺序及推荐运动内容为核心的七个方面，共32条最佳证据。
总结出的证据可为机械通气的ICU-AW患者早期运动康复的标准化评估和干预提供循证依据。ICU医护人员需结合实际临床环境、患者个体差异及康复目标，为预防机械通气患者发生ICU-AW提供针对性的健康指导和干预。
