Zhou Yan, Liu Yubao, Han Yutong, Yan Hongxia
Technol Health Care. 2025;33(1):671-683. doi: 10.3233/THC-241542.
Intensive care unit acquired weakness (ICU-AW) is a secondary neuromuscular complication in critically ill patients, characterized by profound weakness in all four limbs. Studies have shown that bundles of care are nursing strategies that combine a series of evidence-based interventions, which collectively optimize patients' clinical outcomes compared to individual interventions.
This study aims to conduct a meta-analysis of the effects of bundle interventions on ICU-AW deeply exploring the characteristics of bundle interventions, patient outcomes related to ICU-AW, and primarily investigating the effects of bundle interventions on ICU-AW. The main focus is to explore the clinical value of bundle interventions in treatment of ICU-acquired weakness in patients.
Computer and manual searches were conducted using keywords to retrieve relevant studies on the effects of bundle interventions on ICU-AW from databases such as PubMed, Web of Science, Cochrane Library and EMbase. The search period ranged from database inception to the present. The control group received standard ICU care, including basic nursing, while the intervention group received bundle nursing interventions.
A total of 10 randomized controlled trials (RCTs) involving 1545 participants (790 in the intervention group and 755 in the control group) were included. Meta-analysis results showed that the intervention group had significantly higher muscle strength (MD = 7.41, 95% CI: 6.65-8.16, P< 0.00001) and daily living ability (MD = 34.01, 95% CI: 32.54-35.48, P< 0.00001) than the control group. Additionally, the incidence of ICU-AW (OR = 0.39, 95% CI: 0.26-0.59, P< 0.00001), mechanical ventilation time (MD =-3.71, 95% CI: -3.58∼-2.76, P< 0.0001), and ICU length of stay (MD =-2.73, 95% CI: -3.14∼-2.31, P< 0.00001) were significantly lower in the intervention group than in the control group.
ICU-AW has a severe negative impact on the recovery and functional restoration of ICU patients, increasing the treatment complexity for healthcare providers and the mortality and disability rates for patients. The bundled care approach may help reduce the incidence of ICU-AW, promote the restoration of daily activity function, enhance muscle strength, and reduce ICU stay and mechanical ventilation time for ICU patients. However, the long-term effects of bundle interventions still require further in-depth research.
重症监护病房获得性肌无力（ICU-AW）是危重症患者的一种继发性神经肌肉并发症，其特征为四肢严重无力。研究表明，集束化护理是一种结合了一系列循证干预措施的护理策略，与单独干预相比，这些措施共同优化了患者的临床结局。
本研究旨在对集束化干预对ICU-AW的影响进行荟萃分析，深入探究集束化干预的特点、与ICU-AW相关的患者结局，并主要研究集束化干预对ICU-AW的影响。主要重点是探讨集束化干预在治疗患者ICU获得性肌无力方面的临床价值。
使用关键词通过计算机和手工检索，从PubMed、科学网、Cochrane图书馆和EMbase等数据库中检索关于集束化干预对ICU-AW影响的相关研究。检索期从各数据库建库至目前。对照组接受标准的ICU护理，包括基础护理，而干预组接受集束化护理干预。
共纳入10项随机对照试验（RCT），涉及1545名参与者（干预组790名，对照组755名）。荟萃分析结果显示，干预组的肌肉力量（MD = 7.41，95%CI：6.65 - 8.16，P < 0.00001）和日常生活能力（MD = 34.01，95%CI：32.54 - 35.48，P < 0.00001）显著高于对照组。此外，干预组的ICU-AW发生率（OR = 0.39，95%CI：0.26 - 0.59，P < 0.00001）、机械通气时间（MD = -3.71，95%CI：-3.58 ∼ -2.76，P < 0.0001）和ICU住院时间（MD = -2.73，95%CI：-3.14 ∼ -2.31，P < 0.00001）均显著低于对照组。
ICU-AW对ICU患者的康复和功能恢复有严重负面影响，增加了医护人员的治疗复杂性以及患者的死亡率和残疾率。集束化护理方法可能有助于降低ICU-AW的发生率，促进日常活动功能的恢复，增强肌肉力量，并减少ICU患者的住院时间和机械通气时间。然而，集束化干预的长期效果仍需要进一步深入研究。
