Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta...Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.展开更多
Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary a...Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.展开更多
The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if t...The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if the publication of these trials has influenced the use of EGDT when caring for patients with severe sepsis and septic shock in the emergency department (ED). In February 2014, we surveyed a sample of board-certified emergency medicine physicians regarding their use of EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT following the publication of the above trials. Subgroup analyses were also performed with regard to academic affiliation and emergency department volume. Surveys were sent to 308 and 350 physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI 40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased EGDT use following the sepsis trilogy while nonacademic departments significantly increased EGDT use. Use of EGDT was significantly greater in community departments versus academic departments following the publication of the sepsis trilogy. There was no change overall in the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup analyses revealed that academic departments decreased their use of EGDT while community departments increased use of EGDT. This may be due to varying rates of uptake of the medical literature between academic and community healthcare systems.展开更多
目的分析ICU机械通气患者早期活动的研究热点和发展趋势。方法检索2000—2023年中国知网和Web of Science数据库收录的ICU机械通气患者早期活动相关文献。采用CiteSpace可视化软件进行文献分析,并以图谱形式展现文献的发表量、关键词。...目的分析ICU机械通气患者早期活动的研究热点和发展趋势。方法检索2000—2023年中国知网和Web of Science数据库收录的ICU机械通气患者早期活动相关文献。采用CiteSpace可视化软件进行文献分析,并以图谱形式展现文献的发表量、关键词。分析该领域的研究热点与问题。结果检索得到ICU机械通气患者早期活动相关中文文献共116篇,英文文献共145篇。英文文献发文量在波动中增长,中文文献发文量整体稳步增长,均于2020年小幅度回落。研究热点集中于早期活动、机械通气、ICU获得性衰弱、谵妄。中文文献形成早期活动、机械通气、护理、综述、肌力等11个聚类;英文文献形成critical care、delirium、pilot study等10个聚类。2023年的高频关键词是目标导向。结论国内外学者对ICU机械通气患者早期活动的关注度较高,热点聚焦于早期活动对疾病的影响和效果评价。该领域研究内容较丰富,但循证实践研究较少。展开更多
Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,sur...Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.展开更多
目的系统评价重症监护病房(intensive care unit,ICU)医务人员实施早期康复活动阻碍因素的质性研究,为ICU早期康复的开展提供依据。方法检索PubMed、Web of Science、Embase、Medline、Cochrane Library、CINAHL、中国知网、万方、维普...目的系统评价重症监护病房(intensive care unit,ICU)医务人员实施早期康复活动阻碍因素的质性研究,为ICU早期康复的开展提供依据。方法检索PubMed、Web of Science、Embase、Medline、Cochrane Library、CINAHL、中国知网、万方、维普、SinoMed等数据库中关于ICU医务人员实施早期康复活动体验的质性研究。检索时限从建库至2023年4月。采用汇集性整合法进行Meta整合。结果共纳入13篇文献,提取27个结果,归纳9个类别,3个整合结果:人员观念因素;实践因素;资源及管理因素。结论诸多因素阻碍ICU医务人员早期康复活动的实施,未来应提高患者康复认知,构建个性化循证康复方案,统筹多学科团队协作及培训模式,合理增补资源及分配。展开更多
文摘Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.
文摘Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.
文摘The management of sepsis evolved recently with the publication of three large trials (referred to as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was to determine if the publication of these trials has influenced the use of EGDT when caring for patients with severe sepsis and septic shock in the emergency department (ED). In February 2014, we surveyed a sample of board-certified emergency medicine physicians regarding their use of EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT following the publication of the above trials. Subgroup analyses were also performed with regard to academic affiliation and emergency department volume. Surveys were sent to 308 and 350 physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI 40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased EGDT use following the sepsis trilogy while nonacademic departments significantly increased EGDT use. Use of EGDT was significantly greater in community departments versus academic departments following the publication of the sepsis trilogy. There was no change overall in the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup analyses revealed that academic departments decreased their use of EGDT while community departments increased use of EGDT. This may be due to varying rates of uptake of the medical literature between academic and community healthcare systems.
文摘目的分析ICU机械通气患者早期活动的研究热点和发展趋势。方法检索2000—2023年中国知网和Web of Science数据库收录的ICU机械通气患者早期活动相关文献。采用CiteSpace可视化软件进行文献分析,并以图谱形式展现文献的发表量、关键词。分析该领域的研究热点与问题。结果检索得到ICU机械通气患者早期活动相关中文文献共116篇,英文文献共145篇。英文文献发文量在波动中增长,中文文献发文量整体稳步增长,均于2020年小幅度回落。研究热点集中于早期活动、机械通气、ICU获得性衰弱、谵妄。中文文献形成早期活动、机械通气、护理、综述、肌力等11个聚类;英文文献形成critical care、delirium、pilot study等10个聚类。2023年的高频关键词是目标导向。结论国内外学者对ICU机械通气患者早期活动的关注度较高,热点聚焦于早期活动对疾病的影响和效果评价。该领域研究内容较丰富,但循证实践研究较少。
文摘Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.
文摘目的系统评价重症监护病房(intensive care unit,ICU)医务人员实施早期康复活动阻碍因素的质性研究,为ICU早期康复的开展提供依据。方法检索PubMed、Web of Science、Embase、Medline、Cochrane Library、CINAHL、中国知网、万方、维普、SinoMed等数据库中关于ICU医务人员实施早期康复活动体验的质性研究。检索时限从建库至2023年4月。采用汇集性整合法进行Meta整合。结果共纳入13篇文献,提取27个结果,归纳9个类别,3个整合结果:人员观念因素;实践因素;资源及管理因素。结论诸多因素阻碍ICU医务人员早期康复活动的实施,未来应提高患者康复认知,构建个性化循证康复方案,统筹多学科团队协作及培训模式,合理增补资源及分配。
