严重病患者的腿部循环人体工程学 - - 更新的系统性审查和元分析
Heather K O'Grady1, Hibaa Hasan1, Bram Rochwerg2,3
1School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
NEJM evidence
|October 9, 2024
概括
在重症监护室 (ICU) 进行循环人体力测量可以改善身体功能,并减少重症患者住院的时间. 证据确定性低至中等,不常见的不良事件.
科学领域:
- 临界护理医学 临界护理医学
- 康复疗法 康复疗法
- 证据综合 证据综合
背景情况:
- 重症监护室 (ICU) 停留可能导致严重的ICU后损伤.
- 循环人体工程学是一种在ICU环境中使用的康复策略.
- 缓解这些损伤是重症监护恢复的关键目标.
研究的目的:
- 系统地审查和总结关于ICU周期人体素学的疗效和安全性的证据.
- 评估骑自行车干预措施对身体功能和停留时间的影响.
- 评估对重症患者死亡率和不良事件的影响.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析.
- 纳入标准:重症成人在ICU>24小时,比较骑自行车对照.
- 主要结局:身体功能;次要结局:ICU/住院停留时间,死亡率,不良事件. 使用GRADE评估的确定性.
主要成果:
- 包括33个RCT (3274名患者). 骑自行车可以改善ICU和医院出院后 (低确定性) 的身体功能.
- 骑自行车可能会减少ICU住院时间 (低确定性),可能会减少住院时间 (中等确定性).
- 没有观察到对ICU死亡率的显著影响 (确定性低). 不良事件不常见 (1-2%).
结论:
- 在ICU中循环人体工程学可以提高身体功能,并减少重症患者住院的时间.
- 证据表明,对身体功能和停留时间有潜在的益处,不良事件的风险较低.
- 对大多数结果的证据确定性低至非常低,突显了进一步高质量的研究的需要.
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