手術用集中治療室での早期の目標指向の動員:ランダム化制御試験
Stefan J Schaller1, Matthew Anstey2, Manfred Blobner1
1Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Lancet (London, England)
|October 7, 2016
まとめ
手術用集中治療室 (SICU) に早期に移動させることで,患者の移動能力と機能的独立性が著しく改善されました. この介入は重症患者の SICU 滞在期間も短縮しました
科学分野:
- クリティカル ケア 医療
- 回復医療
- 手術 の 結果
背景:
- 不動化は,手術用集中治療室 (SICU) の患者の有害な結果と関連しています.
- 早期の動員試みは 潜在的な利益にもかかわらず しばしば制限されます
- この研究では,SICU患者への早期動員の影響が調査されました.
研究 の 目的:
- SICUでの患者の移動性を改善するかどうかを判断する.
- SICUの滞在期間に対する早期動員効果を評価する.
- 退院時の機能的独立性への影響を評価する.
主な方法:
- 5つの大学病院の SICU の200人の患者を対象とした多センターのランダム化制御試験です.
- 患者は標準的なケアまたはSICU 最適な動員スコア (SOMS) アルゴリズムを使用した早期の目標指向の動員プロトコルに割り当てられました.
- 主なアウトカムは,達成された平均SOMSレベルであり,二次的なアウトカムには,SICUの滞在期間と退院時のミニ修正機能的独立度量 (mmFIM) のスコアが含まれていました.
主要な成果:
- 早期の動員により,達成されたSOMSレベル (2.2対1.5,p<0.0001) が有意に改善されました.
- 介入グループは,より短いSICU滞在期間 (平均7日対10日,p=0. 0054) を経験しました.
- 退院時の機能的モビリティは,介入グループで有意に改善された (mmFIMスコア8対5,p=0,0002).
結論:
- SICU 入院中の患者の移動性を改善するのに有効です.
- このアプローチは SICU の滞在時間を短縮します.
- 早期の動員により 退院時に 患者の機能的移動能力が向上します
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