世界危重病急救学杂志(英文版)最新文献

{"title":"Use of radiograph scoring systems to assess pulmonary disease severity in patients with COVID-19 pneumonia.","authors":"Hayder Mohammed, Khalid Y Fadul, Syed G A Naqvi, Nadir Kharma, Alhady Alfian Yusof, Shabbir Ahmad, Munawar Farooq, Sasha Javid, Ahmed Mohamed, Manar E Abdel-Rahman, Tim Harris","doi":"10.5492/wjccm.v15.i1.113684","DOIUrl":"10.5492/wjccm.v15.i1.113684","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome coronavirus 2 causes pneumonia in most hospitalized patients, often leading to hypoxemia and the need for supplemental oxygen. While chest computed tomography is highly sensitive, chest radiographs (CXR) offer a practical alternative in high-volume settings. Scoring systems like Radiographic Assessment of Lung Edema (RALE) and BRIXIA standardize CXR interpretation and quantify severity, but their relationship with oxygen delivery requirements in coronavirus disease 2019 (COVID-19) patients remains unclear.</p><p><strong>Aim: </strong>To evaluate whether the initial emergency department (ED) radiograph could predict subsequent oxygen support requirements. The secondary aim was to assess inter- and intra-rater agreement of the scoring systems.</p><p><strong>Methods: </strong>This retrospective cohort study examined consecutive COVID-19 patients presenting to a large tertiary hospital ED (May-June 2020) who required admission and underwent CXR within 24 hours of arrival. Infiltrate severity on ED radiographs was scored using the BRIXIA and RALE systems. Oxygen support was categorized by delivery device, and associations were examined using logistic regression.</p><p><strong>Results: </strong>Data was analyzed from 950 COVID-19 patients (90.6% male, mean age: 48.4 ± 12.3 years). Predictive performance showed notable variation: At ED admission, both BRIXIA and RALE scores had the highest discriminatory ability [area under the curve (AUC) = 0.74; 95% confidence interval (CI): 0.69-0.79] for predicting oxygen delivery <i>via</i> high flow nasal cannula/continuous positive airway pressure/Bi-level positive airway pressure. Prediction for non-rebreather mask yielded lower AUCs (BRIXIA: 0.65; RALE: 0.62), with nasal cannula use showing limited discrimination (BRIXIA: 0.56; RALE: 0.54). During hospitalization, predictive performance remained modest across all modalities. The AUCs for intubation were 0.63 (BRIXIA) and 0.62 (RALE), while for high flow nasal cannula/continuous positive airway pressure/Bi-level positive airway pressure, values dropped slightly to 0.62 and 0.59, respectively. Non-rebreather mask prediction maintained an AUC of 0.62 for both scores, and nasal cannula predictions remained low (BRIXIA: 0.56; RALE: 0.52). Inter- and intra-rater agreement was excellent in both scores, with inter-rater agreement at 95% (95%CI: 0.94-0.96) and intra-rater agreement at 97% (95%CI: 0.96-0.98) for BRIXIA and 98% (95%CI: 97-98) for RALE.</p><p><strong>Conclusion: </strong>Both RALE and BRIXIA scores effectively predicted the need for advanced respiratory support in ED COVID-19 patients and demonstrated excellent inter-rater and intra-rater reliability. While their predictive power diminished during hospitalization, both scores remain valuable for initial triage, with BRIXIA particularly useful for ruling out the need for high-level oxygen support.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113684"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the implementation of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia.","authors":"Adam D Laytin, Ayalew Zewdie, Menbeu Sultan, Amelia J Brandt, Ararso B Olani, Geremew Werkeshe, Sean M Berenholtz, William Checkley, Bhakti Hansoti","doi":"10.5492/wjccm.v15.i1.115938","DOIUrl":"10.5492/wjccm.v15.i1.115938","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) capacity is underdeveloped in sub-Saharan Africa, and outcomes for critical care lag behind higher resource settings. It is essential to understand local case-mix, processes of care and clinical outcomes in African ICUs to close these gaps. To this end, ICU registries are valuable tools for clinical research, quality improvement and capacity building. The Critical Care in Asia and Africa (CCAA) Network has specially developed a novel ICU registry for resource-limited settings.</p><p><strong>Aim: </strong>To evaluate the feasibility, acceptability, and perceived sustainability of the CCAA ICU registry in the Ethiopian clinical context.</p><p><strong>Methods: </strong>Eight months following the pilot implementation of the CCAA ICU registry at two academic medical centers in Addis Ababa, Ethiopia, we conducted a qualitative evaluation. We conducted key informant interviews and focus group discussions with members of the ICU registry team, medical and nursing staff, and leadership team. We coded and analyzed transcripts deductively using a thematic content approach.</p><p><strong>Results: </strong>Emergent themes related to feasibility included data collection, data quality and factors necessary for success. Those related to acceptability included utility, accessibility and comparison to other methods. Those related to perceived sustainability included institutional future, ownership and expansion. Overall, respondents felt that the CCAA ICU registry was feasible and acceptable in their ICUs. They identified important threats to perceived sustainability including multiple channels of communication and infrastructure and human resource limitations, and proposed adaptations to address these threats.</p><p><strong>Conclusion: </strong>The CCAA ICU registry is a promising tool for research and quality improvement in ICUs in sub-Saharan Africa, but successful implementation requires a clear understanding of regional and institutional influencing factors.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"115938"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapy approaches for pain control in patients who are critically ill.","authors":"Ana Claudia Ometto, Gustavo Brasil Marcelino, Gabriella Cristina Nogueira Pereira, Felipe Farah Pinheiro Rodrigues, Raquel Afonso Caserta Eid, Arnaldo Alves da Silva","doi":"10.5492/wjccm.v15.i1.108062","DOIUrl":"10.5492/wjccm.v15.i1.108062","url":null,"abstract":"<p><p>Pain is a significant challenge in critical care settings, affecting patient outcomes, recovery time, and quality of life. While pharmacological interventions remain the cornerstone of pain management in intensive care units (ICUs), they are associated with numerous adverse effects including respiratory depression, delirium, and prolonged ICU stays. To examine evidence-based physiotherapy approaches that can effectively complement traditional pain management strategies in patients who are critically ill. We conducted a comprehensive literature review of physiotherapy modalities used for pain control in ICU settings. The review focused on six key interventions: Early mobilization, positioning, postural management, manual therapy techniques, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and photobiomodulation (PBM). Evidence supports the efficacy of physiotherapy interventions in reducing pain intensity and improving patient comfort in critical care environments. Early mobilization prevents complications of immobility while indirectly reducing pain through improved circulation and endorphin release. Proper positioning techniques alleviate pressure on painful areas and reduce the incidence of pressure injuries. Manual therapy provides pain relief through neural mobilization and muscle relaxation. Thermotherapy offers significant analgesic effects with minimal side effects. TENS and PBM demonstrate promising results as nonpharmacological pain management options, with PBM showing efficacy through its impact on cellular metabolism and neural pathways. Evidence supports physiotherapy interventions as effective nonpharmacological adjuncts to conventional pain management in critical care, demonstrating efficacy through multiple modalities that enhance patient comfort while potentially reducing opioid requirements.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"108062"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilatory strategies in intensive care: Balancing clinical outcomes and cost-effectiveness.","authors":"Orivaldo Alves Barbosa","doi":"10.5492/wjccm.v15.i1.113310","DOIUrl":"10.5492/wjccm.v15.i1.113310","url":null,"abstract":"<p><p>Ventilatory strategies shape both outcomes and healthcare expenditures in acute respiratory failure. In resource-limited settings, choosing interventions that provide the greatest value is crucial. Evidence from India indicates that non-invasive ventilation may reduce mortality, intensive care unit stay, and treatment costs to nearly one-fifth of those associated with invasive mechanical ventilation. Comparative data from other low-income and middle-income countries reinforce the importance of prioritizing scalable, protocolized strategies with favorable cost-effectiveness profiles. This editorial discusses why economic considerations are indispensable in critical care, highlights key limitations in available studies, and emphasizes that the value of ventilatory support depends heavily on context - particularly pricing, capacity constraints, and local willingness-to-pay thresholds. Strengthening multicenter economic research, especially in low-income and middle-income countries, is vital to guide policy decisions and ensure equitable, sustainable deployment of ventilatory technologies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 1","pages":"113310"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation and analgesia strategies in the neuro intensive care unit.","authors":"Zachary I Merhavy, Tereque Raeburn, Gloria M Torres-Ayala, Melissa A McCulloch, Thomas C Varkey","doi":"10.5492/wjccm.v14.i4.111787","DOIUrl":"10.5492/wjccm.v14.i4.111787","url":null,"abstract":"<p><p>Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit (neuro ICU); one such challenge is the level of illness and the need for sedation, inhibiting the provider's ability to adequately assess the patient. Most sedatives alter neurological and physical exam findings, only compounding potential barriers to providing the best care for each patient. It is important to emphasize that even in the altered mentation of these patients, physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods, rather than labs or imaging alone. Additionally, selecting the appropriate analgesic(s) and sedative(s) based on these findings are highly important when determining the best course of individualized management. Thus, providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient, but to also better understand how each drug may impact assessment findings. This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs, their risks and benefits, and how providers can best utilize each in practice to further improve patient outcomes. The novel contribution of this work provides comparative drug tables, dosing guidance for pediatric and very elderly (> 85-years-old) populations, and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"111787"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressin role in hypertrophic obstructive cardiomyopathy post-cardiac surgery: A case report.","authors":"Dimitrios Elaiopoulos, Fotios Dimitriadis, Eleni Tzatzaki, Maria Chronaki, Konstantina Kolonia, Michalis Antonopoulos, Giorgos Konstantinou, Nektarios Kogerakis, Stavros Dimopoulos","doi":"10.5492/wjccm.v14.i4.106485","DOIUrl":"10.5492/wjccm.v14.i4.106485","url":null,"abstract":"<p><strong>Background: </strong>Managing left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM) of the mitral valve can be challenging, especially in the context of circulatory shock and pulmonary edema post cardiac surgery.</p><p><strong>Case summary: </strong>We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy. The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit. She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine, furosemide, and esmolol infusion and continuous positive pressure ventilation. The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine. The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO, confirmed by transthoracic echocardiography assessment, improved oxygenation and increased urine output.</p><p><strong>Conclusion: </strong>Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery, because of its absence of inotropic effects. Echocardiography is crucial for early diagnosis and therapeutic management.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"106485"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury in critically ill patients with traumatic brain injury: A single-center retrospective cohort study.","authors":"Bhushan Sudhakar Wankhade, Mohamed Hamed Ibrahim Ali El Kholi, Zeyad Faoor Alrais, Adel Elsaid Salem Elkhouly, Gopala Arun Kumar Naidu, Alim Akbar Patel, Mohamed Sameer, Mohammed Shahid Abbas, Nowar Nouralla Fadol Elbasier, Aala Fadlalla El Hadi","doi":"10.5492/wjccm.v14.i4.110079","DOIUrl":"10.5492/wjccm.v14.i4.110079","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is the second most common presentation of trauma victims. Among the various non-neurological complications after TBI, acute kidney injury (AKI) is not uncommon.</p><p><strong>Aim: </strong>To establish the incidence, risk factors, and predictors of AKI in TBI victims. The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale (GCS) ≤ 11 in an apex trauma center in a metropolitan city.</p><p><strong>Results: </strong>The incidence of AKI after TBI was 11%. The risk factors for AKI after TBI were old age (<i>P</i> < 0.001), comorbidities (<i>P</i> = 0.023), shock (<i>P</i> < 0.001), blood transfusion (<i>P</i> = 0.016), consecutive neurosurgical intervention (<i>P</i> = 0.029), high intracranial pressure (ICP) (<i>P</i> < 0.001), rhabdomyolysis (<i>P</i> < 0.001), and diabetes insipidus (<i>P</i> < 0.001). The predictors of AKI after TBI were, on point-biserial correlation: Lower GCS (<i>r_pb</i> = -0.27, <i>n</i> = 331, <i>P</i> < 0.001); and on multivariate logistic regression: (1) Shock (odds ratio [OR]: -11.94, <i>P</i> < 0.001); (2) Rhabdomyolysis (OR: -7.33, <i>P</i> = 0.001); (3) High ICP (OR: -4.39, <i>P</i> = 0.018); (4) High Carlson comorbidity index (OR: -1.97, <i>P</i> = 0.001); and (5) High acute physiology and chronic health evaluation-2 (APACHE-2) score (OR: -1.13, <i>P</i> < 0.001). The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit (<i>P</i> = 0.008), demand for ventilators (<i>P</i> = 0.0170), ventilator days (<i>P</i> < 0.001), incidence of brain death (<i>P</i> < 0.001), and mortality (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Every tenth TBI victim suffers from AKI. AKI after TBI can be predicted by the patient's underlying comorbidities, on arrival low GCS, high APACHE-2 score, shock, rhabdomyolysis, and high ICP. The occurrence of AKI in TBI victims adversely affects outcome variables; however, this may be a reflection of the severe nature of TBI in the AKI group. New research is needed to understand the effects of AKI on outcome variables.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"110079"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid storm-induced cardiovascular complications and modalities of therapy: Up-to-date review.","authors":"Ayman El-Menyar, Naushad Ahmad Khan, Eman Elmenyar, Başar Cander, Lukasz Szarpak, Vimal Krishnan S, Sagar Galwnkar, Hassan Al-Thani","doi":"10.5492/wjccm.v14.i4.109565","DOIUrl":"10.5492/wjccm.v14.i4.109565","url":null,"abstract":"<p><p>A thyroid storm (TS) or thyrotoxic crisis is an infrequent, life-threatening endocrinological emergency due to the worsening of the hyperthyroid state. Thyroid hormones (THs) influence almost all the body cells and tissues' differentiation, growth, and energy metabolism. Consequently, excess THs are expected to lead to profound organ function, regulation, and hemodynamic changes. In addition to their roles in metabolism and thermoregulation, THs play critical role in maintaining cardiovascular homeostasis through both genomic and non-genomic mechanisms. Receptors for THs are expressed in myocardial and vascular endothelial tissues, allowing fluctuations in circulating hormone levels to directly influence cardiovascular function. Excess TS induces a hyper-dynamic cardiovascular state, characterized by increased ventricular contractility and improved systolic and diastolic performance. The chronotropic and inotropic properties of THs result in dysregulation of blood pressure, heart rate, contractility, cardiac output, and systemic vascular resistance. This could lead to serious consequences such as cardiomyopathy, heart failure, and life-threatening arrhythmia, ultimately contributing to cardiocirculatory collapse and cardiac death. The management of TS necessitates a systematic approach that emphasizes the significance of resuscitation and identification of the underlying causes. It is crucial to prioritize assessing cardiac function in patients with TS. This review explores the clinical impact of TS on the heart and its clinical repercussions, emphasizing the intricate molecular and pathophysiological mechanisms and the interplay between TS and key cardiovascular parameters. This review summarizes the current knowledge of pathophysiology, pharmacological and mechanical interventions, ranging from beta-blocker use to the surgical approach.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"109565"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ivabradine in acute care: Revisiting the funny current in critical care context.","authors":"Arun Mukesh, Ankur Sharma, Nikhil Kothari","doi":"10.5492/wjccm.v14.i4.111054","DOIUrl":"10.5492/wjccm.v14.i4.111054","url":null,"abstract":"<p><p>Ivabradine, a selective inhibitor of the funny current in the sinoatrial node, has emerged as a promising agent for heart rate modulation in acute and critical care settings. Unlike beta-blockers, ivabradine reduces heart rate without affecting myocardial contractility, making it a valuable option for patients contraindicated for traditional therapies. This review examines its mechanism of action, clinical applications, comparative efficacy, and safety profile. It incorporates recent literature to assess its expanding role in managing acute coronary syndrome, acute decompensated heart failure, and sepsis-induced tachycardia.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"111054"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and early mobilization in intensive care unit patients: An updated systematic review and meta-analysis of randomized controlled trials.","authors":"Syed A Khan, Abdul Moeed, Tahreem Mari, Zehra Yousuf, Arthur Hanson, Yue Dong, Patrick Cornelius, Humayun Anjum, Iqbal Ratnani, Salim Surani","doi":"10.5492/wjccm.v14.i4.107396","DOIUrl":"10.5492/wjccm.v14.i4.107396","url":null,"abstract":"<p><strong>Background: </strong>Prolonged immobility during intensive care unit (ICU) admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times. Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.</p><p><strong>Aim: </strong>To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic search was performed through MEDLINE, Scopus, and Cochrane Library from inception until September 2024 for randomized controlled trials (RCTs) comparing early mobilization (EM) with usual or conventional care in critically ill adult patients. Primary outcomes included length of ICU (days) and ventilation duration (days). Secondary outcomes included muscle strength, functional status, adverse events, all-cause mortality, and quality of life (QOL). A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios (RR) and corresponding 95% confidence intervals (CI).</p><p><strong>Results: </strong>Out of 3487 results, 16 RCTs were included with a population of 2385 patients (1195 receiving EM and 1190 with usual care.) A significant reduction in the length of ICU stays [mean difference (MD) = -1.02, 95%CI: -1.96 to -0.09; <i>P</i> = 0.03; <i>I</i> ² = 60%] and ventilation duration (MD = -1.07, 95%CI: -1.91 to -0.23, <i>P</i> = 0.01; <i>I</i> ² = 57%) was observed in the EM group compared to usual care. EM significantly improved muscle strength [standard MD (SMD) = 0.47, 95%CI: 0.18-0.75, <i>P</i> = 0.001; <i>I</i> ² = 79%] and functional status (SMD = 0.70, 95%CI: 0.40-1.00, <i>P</i> < 0.00001; <i>I</i> ² = 81%) in ICU patients. No statistically significant difference was observed in adverse events (RR = 1.72, 95%CI: 1.01-2.94, <i>P</i> = 0.05; <i>I</i> ² = 31%), all-cause mortality (RR = 1.10, 95%CI: 0.79-1.53, <i>P</i> = 0.57; <i>I</i> ² = 30%), and QOL (SMD = 0.04, 95%CI: -0.07-0.15, <i>P</i> = 0.50; <i>I</i> ² = 9%) between the two groups.</p><p><strong>Conclusion: </strong>Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration. These findings indicate that EM may be a safe option for ICU patients, contributing to lower recovery times and healthcare costs. Further extensive research is required to validate the long-term effects on survival and QOL.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 4","pages":"107396"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}