Early intensive care unit mobility therapy in the treatment of acute respiratory failure

被引：1011

作者：

Morris, Peter E. ^{[1
]}

Goad, Amanda ^{[2
,3
,4
]}

Thompson, Clifton ^{[2
,3
,4
]}

Taylor, Karen ^{[2
,3
,4
]}

Harry, Bethany ^{[2
,3
,4
]}

Passmore, Leah

Ross, Amelia ^{[2
,3
,4
]}

Anderson, Laura ^{[2
,3
,4
]}

Baker, Shirley ^{[2
,3
,4
]}

Sanchez, Mary ^{[2
,3
,4
]}

Penley, Lauretta ^{[2
,3
,4
]}

Howard, April ^{[1
]}

Dixon, Luz ^{[2
,3
,4
]}

Leach, Susan ^{[2
,3
,4
]}

Small, Ronald ^{[2
,3
,4
]}

Hite, R. Duncan ^{[1
]}

Haponik, Edward ^{[1
]}

机构：

[1] Wake Forest Univ, Sch Med, Sect Pulm Crit Care Allergy & Immunol Dis, Winston Salem, NC 27109 USA

[2] N Carolina Baptist Hosp, Dept Nursing, Winston Salem, NC 27103 USA

[3] N Carolina Baptist Hosp, Dept Phys Therapy, Winston Salem, NC 27103 USA

[4] N Carolina Baptist Hosp, Dept Hosp Adm, Winston Salem, NC 27103 USA

来源：

CRITICAL CARE MEDICINE | 2008年 / 36卷 / 08期

关键词：

respiratory failure; mechanical ventilation; mobility; intensive care units; physical therapy; passive range of motion;

D O I：

10.1097/CCM.0b013e318180b90e

中图分类号：

R4 [临床医学];

学科分类号：

1002 [临床医学]; 100602 [中西医结合临床];

摘要：

Objective. Immobilizabon and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. Design and Setting: Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. Patients. Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. Interventions: An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. Measurements and Main Results. The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p <= .001). Protocol patients were out of bed earlier (5 vs. 11 days, p <=.001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p <= .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p =.006) (intensive care unit/hospitall length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation 11, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. Conclusions: A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patents who received usual care.

引用

页码：2238 / 2243

页数：6

共 18 条

[1]

[Anonymous], 2004, HOSP EPIDEMIOLOGY IN

[2]

Early activity is feasible and safe in respiratory failure patients [J].