早期机械通风,重症患者的物理和职业治疗:一个随机对照试验
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
概括
早期康复,将镇静中断与身体和职业治疗相结合,改善了重症患者的功能结果. 这种干预措施还减少了妄想的持续时间,增加了无呼吸器的日子,增强了重症监护室 (ICU) 停留后的康复.
科学领域:
- 关键护理医学 关键护理医学
- 康复医学是康复的医学.
- 神经临界护理是指神经临界护理.
背景情况:
- 长期的严重疾病可能导致重症监护室 (ICU) 获得的虚弱和神经精神问题.
- 由于镇静而导致的固定可能会加剧这些长期并发症.
- 目前正在研究早期的综合康复策略,以减轻这些影响.
研究的目的:
- 评估每日镇静中断与物理和职业治疗相结合的疗效.
- 评估这种综合策略对机械通风ICU患者的功能结果的影响.
- 将干预组与接受标准护理的对照组进行比较.
主要方法:
- 进行了一项随机对照试验,其中有104名接受镇静治疗的机械通风的成年患者.
- 患者被分配到每日镇静中断 (干预) 或标准护理 (控制) 期间的早期运动和动员.
- 主要终点是医院出院时恢复独立的功能状态,定义为日常生活活动和独立行走.
主要成果:
- 干预组的59%的患者恢复了独立的功能状态,对照组的35% (p=0.02).
- 干预组的妄持续时间较短 (中位数为2.0 vs 4.0天,p=0.02).
- 接受干预的患者也有更多的无呼吸器日 (p=0.05),该策略被认为是安全的.
结论:
- 整体康复策略,包括镇静中断和早期物理/职业疗法,是安全的,耐受性良好.
- 这种方法显著改善了重症患者在医院出院时的功能结果.
- 与标准护理相比,这种干预导致 Delirium 持续时间更短,无呼吸器的日子更长.
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