广泛的早期动员和康复方案对入住重症监护病房的创伤患者预后的影响：一项回顾性的前后研究

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-07-30 DOI:10.1186/s13054-025-05570-w

Tsuyoshi Ichikawa, Asuka Tsuchiya, Yusuke Tsutsumi, Tatsuya Okawa, Daisuke Kubo, Yu Horimizu, Ryo Tsutsui, Hina Shukumine, Kento Noda, Katsuhiro Mizuno

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引用次数: 0

摘要

由于有限的随机对照试验和观察性研究的方法学局限性，早期动员和康复方案（EMRP）对入住重症监护病房（ICU）的创伤患者的影响尚不清楚。本研究旨在比较EMRP实施前后入住ICU的创伤患者的临床结果。对某大学附属医院ICU收治的损伤严重程度评分≥9的成人创伤患者进行回顾性前后研究。2021年7月至2022年6月入院的患者为emrp前组，而2022年7月至2023年8月入院的患者为emrp后组。使用倾向评分匹配来调整混杂因素，比较两组之间的结果。主要观察指标为出院率。次要指标为出院时Barthel指数评分、ICU和医院住院时间（LOS）；ICU出院时功能状态评分；患者入院后28天内ICU活动能力评分(IMS)≥3、≥4、≥7的累计率。在552名符合条件的患者中，分别有254名和298名患者在emrp前和emrp后阶段入院。在倾向评分匹配的队列中，emrp后组的出院比例较高（52.1%比41.1%，差异为11.0%，95%可信区间[CI]: 1.7 ~ 20.2%），出院时Barthel指数得分较高（95.0[55.0 ~ 100.0]比80.0 [40.0 ~ 100.0],P = 0.007）， ICU的LOS较短（5.0[3.0 ~ 11.0]比7.0[4.0 ~ 11.0]天，P = 0.03）。EMRP与IMS水平≥3（风险比[HR]: 1.29, 95% CI: 1.06-1.57）、≥4（风险比：1.27,95% CI: 1.03-1.56）和≥7（风险比：1.36,95% CI: 1.08-1.70）的患者比例较高相关。与EMRP实施前相比，EMRP对成人创伤患者的家庭出院比例更高，出院时Barthel指数评分更高，ICU的LOS更短。这些发现表明EMRP可能通过改善身体功能来促进回家。

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Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study

The impact of early mobilization and rehabilitation protocol (EMRP) on trauma patients admitted to the intensive care unit (ICU) remains unclear owing to limited randomized controlled trials and methodological limitations in observational studies. This study aimed to compare the clinical outcomes of trauma patients admitted to the ICU before and after EMRP implementation. A retrospective pre–post study was conducted on adult trauma patients having an Injury Severity Score ≥ 9 who were admitted to the ICU of a university hospital. Patients admitted from July 2021 to June 2022 comprised the pre-EMRP group, whereas those admitted from July 2022 to August 2023 comprised the post-EMRP group. Outcomes were compared between these two groups using propensity score matching to adjust for confounders. The primary outcome was the proportion of home discharge. The secondary outcomes were the Barthel Index score at hospital discharge, length of stay (LOS) in the ICU and hospital; Functional Status Score for the ICU at ICU discharge; and cumulative rate of patients reaching ICU Mobility Scale (IMS) levels ≥ 3, ≥4, and ≥ 7 within 28 days after ICU admission. Among 552 eligible patients, 254 and 298 were admitted during the pre-EMRP and post-EMRP phases, respectively. In the propensity score-matched cohort, the post-EMRP group showed a higher proportion of home discharge (52.1% vs. 41.1%, difference: 11.0%, 95% confidence interval [CI]: 1.7–20.2%), higher Barthel Index score at hospital discharge (95.0 [55.0–100.0] vs. 80.0 [40.0–100.0], P = 0.007), and shorter LOS in the ICU (5.0 [3.0–11.0] vs. 7.0 [4.0–11.0] days, P = 0.03) than the pre-EMRP group. EMRP was associated with a higher rate of patients reaching IMS levels ≥ 3 (hazard ratio [HR]: 1.29, 95% CI: 1.06–1.57), ≥ 4 (HR: 1.27, 95% CI: 1.03–1.56), and ≥ 7 (HR: 1.36, 95% CI: 1.08–1.70). Compared with pre-EMRP implementation, EMRP for adult trauma patients was associated with a higher proportion of home discharge, an improved Barthel Index score at hospital discharge, and a shorter LOS in the ICU. These findings indicate that EMRP may facilitate returning home by improved physical function.

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.