Early Mobilization and Weaning Outcome on Patients With Mechanical Ventilation in the Intensive Care Unit: A Systematic Review and Meta-Analysis

早期活動於加護病房使用呼吸器病人之脫離呼吸器與預後探討：系統性回顧與統合分析

王琮賢(Tsung-Hsien Wang) ； 王淑芬(Shwu-Fen Wang) ； 吳清平(Chin-Pyng Wu) ； 王儷穎(Li-Ying Wang)

《物理治療》 47卷2期 (2022/06) Pp. 87-98

https://doi.org/10.6215/FJPT.202206_47(2).0004

摘要

Background and Purpose: Patients in intensive care unit (ICU) usually experienced immobile and restrained, and these can induce muscle weakness, cognitive impairments, psychological difficulties, difficult weaning and increase length of stay in hospital. Early mobilization has multiple benefits including improved ventilation, perfusion, muscle strength and functional capacity. The purpose of this study was to evaluate the effectiveness of early activity on ventilator duration in ICU, length of ICU stay, reintubation rate, and mortality through meta-analysis in patients with mechanical ventilators in the ICU. Methods: The research question of this meta-analysis is formed based on the PICO strategy. All relevant clinical randomized trial studies from 2008 to 2017 and published in English or Chinese language were collected from PubMed, Embase, PEDro, and Cochrane databases. A study had to describe the early mobilization of patient with mechanical ventilation (MV) in ICU. Patients (aged ＞ 18 years ) admitted to the ICU and having been ventilated for ＞ 24 hours. We included all randomized controlled trial or controlled clinical trial or cohort study that compared early intervention (mobilization or rehabilitation, or both), delivered in the ICU. Results: Eight trials were selected. The mean PEDro score of the included studies was 5.9. The studies were categorized into three groups based on the outcomes discussed: extubation outcome, length of stay in ICU and mortality. Early mobilization had significant effect on duration of MV and length of stay in ICU. Conclusion: Early mobilization in the ICU does have a beneficial effect on patient prognosis, mainly through avoiding bed-bound complications and reducing the number of days on the ventilator and length of ICU stay. Further research should assess of patient heterogeneity that might affect the outcome in early mobilization.

關鍵字

Early mobilization ； Weaning ； Intensive care unit ； Mechanical ventilation ； Critical illness

並列摘要

背景與目的：病人在加護病房常會經歷不能活動或者是被約束，這會導致肌肉無力、認知障礙與精神錯亂等併發症，甚至會造成呼吸器困難脫離與增加住院天數。研究顯示，早期活動有許多優點，包括改善呼吸、灌流、肌肉力量以及功能活動能力。本研究目的為，以系統性回顧與統合分析的方式，評估早期活動對於加護病房使用呼吸器病人之成效，包括呼吸器使用天數、加護病房住院天數、重插管率及死亡率。方法：本系統性回顧依據PICO策略來形成研究問題。從PubMed、Embase、PEDro及Cochrane等資料庫，蒐集所有相關的臨床隨機試驗研究，文獻年代範圍從2008年至2017年間，文章語言為英文與中文，納入標準包括病人轉入加護病房，年紀大於18歲，且呼吸器使用大於24小時。我們納入隨機對照試驗、對照臨床試驗與世代研究。結果：共計8篇期刊論文納入分析。統合分析結果顯示，平均PEDro分數為5.9分。研究主要去探討三個部分，包括：拔管預後、加護病房住院天數及死亡率。結果顯示早期活動跟呼吸器使用天數與加護病房住院天數有顯著相關。結論：加護病房早期活動對於病人預後確實有幫助，主要是避免臥床造成的併發症，並可降低加護病房住院天數與呼吸器使用天數，建議未來研究需要分析病人異質性，藉以了解早期活動對於病人預後的影響。

並列關鍵字

早期活動 ； 脫離 ； 加護病房 ； 呼吸器 ； 重症