危重成人卧床循环治疗的效果：随机临床试验的系统回顾和荟萃分析

IF 4.6 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine Pub Date : 2025-03-18 DOI:10.1016/j.rehab.2025.101953

Rocío Pazo-Palacios, Beatriz Brea-Gómez, Laura Pérez-Gisbert, Marta López-Muñoz, Marie Carmen Valenza, Irene Torres-Sánchez

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引用次数: 0

摘要

重症监护病房（ICU）幸存者的损伤在出院后可持续长达5年。找到有效的治疗方法来缓解和预防它们是至关重要的，而在床上骑自行车是缓解长期固定影响的一种方法。目的探讨卧床循环对危重症成人康复状况、死亡率、身体机能和生活质量的影响。方法遵循PRISMA 2020指南。该搜索在Cinahl， Medline， Scopus和Web of Science上进行，从它们成立到2024年10月。我们纳入了重症成人患者的随机临床试验，这些患者在ICU单独或联合其他治疗进行床上骑行，与不干预、安慰剂、康复或标准治疗进行比较，评估恢复状态、死亡率、身体表现或生活质量。评估方法学质量和偏倚风险。进行meta分析。结果本综述纳入32项研究，meta分析纳入22项研究。共有3052名患者（≥18岁）入住不同类型的icu。结果显示ICU住院时间差异有统计学意义(n = 1564；MD−0.93;95% CI为- 1.64 ~ - 0.21；P = 0.01)和住院时间(n = 1189；MD−1.78;95% CI为−3.16 ~−0.41；P = 0.01)、机械通气时间(n = 1,024；MD−0.51;95% CI为- 0.92 ~ - 0.11；P = 0.01)和功能状态(n = 400；MD 44.88;95% ci 3.11-86.65；P = 0.04)与康复治疗相比，更倾向于卧床骑行加康复治疗。然而，在死亡率、肌肉力量、icu获得性虚弱或生活质量方面没有发现显著差异。不同的方案持续时间对住院时间没有显著影响。结论与康复治疗相比，床上循环加康复治疗可显著减少ICU、缩短住院时间、缩短机械通气时间、改善功能状态。需要进一步的研究来分析长期影响并使干预措施标准化。普洛斯彼罗国际前瞻性系统评价注册CRD42022309311；https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309311。

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Effects of in-bed cycling in critically ill adults: A systematic review and meta-analysis of randomised clinical trials

Background

Impairments in intensive care unit (ICU) survivors can last up to 5 years post-discharge. Finding effective treatments to palliate and prevent them is essential, and in-bed cycling is a way to palliate the effects of prolonged immobilisation.

Objective

To evaluate the effects of in-bed cycling in critically ill adults regarding recovery status, mortality, physical performance and quality of life.

Methods

We followed PRISMA 2020 guidelines. The search was conducted in Cinahl, Medline, Scopus and Web of Science from their inception to October 2024. We included randomised clinical trials with critically ill adults who performed in-bed cycling alone or with another treatment while in ICU, compared to no intervention, placebo, rehabilitation or standard care, assessing recovery status, mortality, physical performance or quality of life. Methodological quality and risk of bias were evaluated. A meta-analysis was performed.

Results

Thirty-two studies were included in the review, and 22 studies in the meta-analysis. A total of 3,052 participants (≥18 years old) admitted to different types of ICUs were included. Results showed significant differences regarding ICU length of stay (n = 1,564; MD −0.93; 95 % CI −1.64 to −0.21; P = 0.01) and hospital length of stay (n = 1,189; MD −1.78; 95 % CI −3.16 to −0.41; P = 0.01), mechanical ventilation duration (n = 1,024; MD −0.51; 95 % CI −0.92 to −0.11; P = 0.01) and functional status (n = 400; MD 44.88; 95 % CI 3.11–86.65; P = 0.04) favouring in-bed cycling plus rehabilitation compared to rehabilitation. However, no significant differences were found regarding mortality, muscle strength, ICU-acquired weakness or quality of life. Different programme duration did not significantly affect hospital length of stay.

Conclusion

In-bed cycling plus rehabilitation significantly reduced ICU and hospital length of stay, mechanical ventilation duration and improved functional status compared to rehabilitation. Further research is needed to analyse long-term effects and standardise interventions.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42022309311; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309311.

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来源期刊

Annals of Physical and Rehabilitation Medicine Medicine-Rehabilitation

CiteScore

7.80

自引率

4.30%

发文量

136

审稿时长

34 days

期刊介绍： Annals of Physical and Rehabilitation Medicine covers all areas of Rehabilitation and Physical Medicine; such as: methods of evaluation of motor, sensory, cognitive and visceral impairments; acute and chronic musculoskeletal disorders and pain; disabilities in adult and children ; processes of rehabilitation in orthopaedic, rhumatological, neurological, cardiovascular, pulmonary and urological diseases.