機械呼吸器を用いた重症患者における早期の物理・職業療法:ランダム化制御試験
William D Schweickert1, Mark C Pohlman, Anne S Pohlman
1Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Lancet (London, England)
|May 19, 2009
まとめ
鎮静剤の中断を物理的および職業療法と組み合わせた早期リハビリテーションは,重症患者の機能的アウトカムを改善しました. この介入はまた,妄想の持続期間を短縮し,呼吸器のない日数を増加させ,集中治療室 (ICU) の滞在後の回復を向上させました.
科学分野:
- クリティカルケア医療は,重症療養医療です.
- リハビリテーション医学は,
- ニューロクリティカルケアとは
背景:
- 長期的な重症は,集中治療室 (ICU) で得られた弱さや神経精神学的問題を引き起こす可能性があります.
- 鎮静剤による不動化は,これらの長期的な合併症を悪化させる可能性があります.
- これらの影響を軽減するために,早期の複合リハビリテーション戦略が調査されています.
研究 の 目的:
- 日々の鎮静療法中断と物理療法および職業療法との組み合わせの有効性を評価する.
- この統合戦略が,機械呼吸器のICU患者における機能的アウトカムに与える影響を評価する.
- 標準的なケアを受ける対照群と介入群を比較する.
主な方法:
- ランダム化比較試験は,機械呼吸器を施した成人患者104人を対象に実施されました.
- 患者は,毎日の鎮静中断 (介入) の間に早期の運動と動員,または標準的なケア (コントロール) に割り当てられました.
- 主要エンドポイントは,退院時に独立した機能状態に戻ることであり,それは日常生活活動と独立歩行によって定義されています.
主要な成果:
- 介入群の患者の59%が独立機能状態に戻ったが,対照群の患者数は35%であった (p=0.02).
- 介入グループでは,妄想の期間が短かった (中位は2.0対4.0日,p=0.02).
- 介入を受けた患者は,呼吸器のない日数が多く (p=0.05) なりましたが,この戦略は安全であることが判明しました.
結論:
- 鎮静剤の中断と早期の物理/職業療法を含む全身リハビリテーション戦略は安全であり,よく耐えます.
- このアプローチは,重症患者の退院時の機能的アウトカムを大幅に改善します.
- この介入により,妄想の持続時間が短縮され,標準的なケアと比較して,呼吸器なしで過ごす日数が増加します.
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