机械通气ICU获得性衰弱患者早期运动康复的最佳证据总结

Summary of the best evidence for early exercise rehabilitation in patients with mechanically ventilated ICU-acquired weakness

目的运用循证的方法整合机械通气ICU获得性衰弱(ICU-AW)患者早期康复的最佳证据,为机械通气ICU-AW患者早期运动治疗规范化评估和干预提供循证依据。方法系统检索美国胸科协会(ATS)临床实践指南、加拿大安大略注册护士协会(RNAO)、国际指南协作网(GIN)、加拿大医学会临床实践指南文库(CMACPGL)、BMJ最佳临床实践、UpToDate临床顾问、苏格兰校际指南网(SIGN)、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库、美国国立指南网(NGC)、荷兰医学文摘Embase数据库、护理和辅助医学文献累积索引(CINAHL)、UM图书馆数据库、物理治疗证据数据库(PEDro)、英国国家卫生与临床优化研究所(NICE)数据库、新西兰指南研究网(NZGG)、中国医脉通指南网站、中国知网、万方数据等中英文数据库、专业团队网站和指南网站有关机械通气ICU-AW患者早期运动康复的专家共识、指南、随机对照试验(RCT)、系统评价等证据,检索时限为建库至2023年12月31日。由2位评价员独立完成文献检索、筛选、评估、提取信息,并交叉核对,同时对纳入文献进行质量评价。结果共纳入21篇文献,其中指南5篇、系统评价5篇、专家共识4篇、RCT 7篇,整体证据等级均较高,均纳入分析。最终归纳总结为以评估筛查、运动安全标准、注意事项、运动时间的设定、运动强度、运动次序、运动内容推荐为核心的七大方面、32条最佳证据。结论总结机械通气ICU-AW患者早期运动康复的最佳证据,可为此类患者早期运动康复规范化评估和干预提供循证依据;ICU医疗从业者需结合实际临床环境、患者个体差异和康复目标,为预防机械通气患者ICU-AW提供有针对性的健康指导和干预。

Objective To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness(ICU-AW)patients using evidence-based methods,providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods A systematic search was conducted on the American Thoracic Society(ATS)Clinical Practice Guidelines,Registered Nurses'Association of Ontario(RNAO),Guidelines International Network(GIN),Canadian Medical Association Clinical Practice Guideline Library(CMACPGL),BMJ Clinical Evidence,UpToDate,Scottish Intercollegiate Guidelines Network(SIGN),PubMed,Cochrane Library,National Guideline Clearinghouse(NGC),Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL),UM-library,Physiotherapy Evidence Database(PEDro),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Chinese Medical Pulse Guidelines Website,CNKI and Wanfang data and other Chinese and English databases,professional team websites,and guideline websites for expert consensus,guidelines,randomized collected trial(RCT),systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients.The search time limit was from the establishment of the database to December 31,2023.Literature search,screening,evaluation,information extraction was independently conducted by two evaluators with cross checking,and quality evaluation of the included literature was conducted.Results A total of 21 literatures were enrolled,including 5 guidelines,5 systematic reviews,4 expert consensuses,and 7 RCT,all of which with high evidence level and all were enrolled.They were summarized into seven aspects with assessment screening,exercise safety standards,precautions,setting of exercise time,exercise intensity,exercise sequence,and recommended exercise content as the core,and 32 best evidences.Conclusions The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients.ICU medical practitioners need to combine the actual clinical environment,individual differences and rehabilitation goals of patients,to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.