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Frontiers of Nursing 2018年第4期5卷 301-310页

作者： Meng Yue Zhan-Ying Ma Meng-Jie Lei Chu-Yun Cui Yi Jin Department of Nursing Tianjin Huanhu Hospital Graduate College Tianjin University of Traditional Chinese Medicine

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 ***: 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 *** outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and ***: 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 ***: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.

关键词： early mobilization exercise mechanical ventilation intensive care unit meta-analysis review

Outcome after early mobilization following hip reconstruction in children with developmental hip dysplasia and luxation

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World Journal of Pediatrics 2018年第2期14卷 176-183页

作者： Katharina Susanne Gather Eva von Stillfried Sebastien Hagmann Sebastian Müller Thomas Dreher Center of Orthopaedic and Trauma Surgery/Spinal Cord Injury Center Heidelberg University HospitalSchlierbacher Landstr.200a69118 HeidelbergGermany

Background Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip *** challenging treatment may be associated with *** are lacking that focus on early mobilization without casting for postoperative care after hip *** Twenty-seven children(3.4±2.0 years),including 33 hips with developmental hip dysplasia(DDH)and dislocation of the hip(Tonnis grade 1 to 4),who underwent hip reconstruction(Dega acetabuloplasty,varisation-derotation osteotomy and facultative open reduction)were retrospectively included in this *** the patients were placed in an individual foam shell with 30 degrees of hip abduction,hip extension,and neutral *** mobilization physiotherapy was performed within the first few days after the surgery under epidural *** weight bearing was allowed after 3-4 *** children received a clinical examination and radiographic evaluation before and after surgical *** follow-up period was 12.3±2.9 *** On average,the postoperative acetabular index decreased significantly from 36.9 to 21.7 degrees and the center-edge angle increased from 9.9 to 28.6 *** hips had reached Tonnis grade 1 at the time of the last *** complications such as dislocation of the bone wedge,avascular necrosis of the acetabulum or femur,lack of non-union,or nerve injury,were *** In this cohort study,hip reconstruction was successful according to clinical and radiographic outcome param-eters after early mobilization without cast *** mobilization may be used as an alternative treatment option after hip reconstruction in DDH.

关键词： Dega acetabuloplasty Developmental hip dysplasia early mobilization Spica cast Varisation-derotation osteotomy

Management of early mobilization in intensive care units:a multicenter cross-sectional study

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Frontiers of Nursing 2018年第4期5卷 291-299页

作者： Yan-Ping Zhu Li-Xia Xia Guo-Hong Li Intensive Care Units Zhongda Hospital Southeast University Department of Nursing Jiangsu Provincial Hospital Department of Nursing Zhongda HospitalSoutheast University

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 ***: 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.

关键词： early mobilization critical care critically ill patients management clinical practice

Cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

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World Journal of Cardiology 2024年第2期16卷 67-72页

作者： Christos Kourek Stavros Dimopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece

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 *** complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality *** the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac *** and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle *** 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 *** exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise *** the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac *** 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.

关键词： Cardiac rehabilitation Cardiac surgery Cardiopulmonary exercise testing early mobilization Treatment Technology

Intensive care unit-acquired weakness–preventive,and therapeutic aspects;future directions and special focus on lung transplantation

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World Journal of Clinical Cases 2024年第19期12卷 3665-3670页

作者： Thirugnanasambandan Sunder Department of Heart Lung Transplantation and Mechanical Circulatory Support Apollo HospitalsChennai 600086Tamil NaduIndia

In this editorial,comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and *** authors describe the use of neural network model to identify risk factors for the development of intensive care unit(ICU)-acquired *** condition has now become common with an increasing number of patients treated in ICUs and continues to be a source of morbidity and *** identification of certain risk factors and corrective measures thereof,lacunae still exist in our understanding of this clinical *** possible pathogenetic mechanisms at a molecular level have been described and these continue to be *** amount of retrievable data for analysis from the ICU patients for study can be huge and *** learning techniques to identify patterns in vast amounts of data are well known and may well provide pointers to bridge the knowledge gap in this *** editorial discusses the current knowledge of the condition including pathogenesis,diagnosis,risk factors,preventive measures,and ***,it looks specifically at ICU acquired weakness in recipients of lung transplantation,because–unlike other solid organ transplants-muscular strength plays a vital role in the preservation and survival of the transplanted *** differ from other solid organ transplants in that the proper function of the allograft is dependent on muscle *** weakness especially diaphragmatic weakness may lead to prolonged ventilation which has deleterious effects on the transplanted lung–ranging from ventilator associated pneumonia to bronchial anastomotic complications due to prolonged positive pressure on the anastomosis.

关键词： Intensive care unit-acquired weakness Critical illness myopathy Critical illness polyneuropathy Critical illness polyneuromyopathy early mobilization Prolonged ventilation Nutritional rehabilitation Lung transplantation

Prospective Study on Effectiveness of Belfast Regime on Flexion Tendon Injury Zone V Using Tam Scoring

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International Journal of Clinical Medicine 2022年第9期13卷 428-439页

作者： Maha Farhina Bushra Zulfiqar Maryam Noor Saba Kiran Faisal Akhlaq Ali Khan Shafa Atullah Plastic Surgery Department Civil Hospital Karachi Karachi Pakistan Baqui Medical University Karachi Karachi Pakistan

About 20% of injuries presented in the emergency room that require surgical repair involve the hand. Most of these injuries result from sharp objects such as glass and knives, and blades in case of suicide. In Pakistan, the most common injuries occur at the junction between the transverse distal crease on the wrist and the forearm muscles (zone 5). Wrist injuries are difficult to repair since they result in the tendon, ulnar and median nerve and arteries abrasion. In addition, an inadequate approach could damage abrasion and swelling of the flexor muscles, risking the functioning of the hand. A good outcome necessitates prioritizing the flexor muscles to avoid swelling and hand dysfunction. The objective of this study is to investigate the effectiveness of Belfast rehabilitation in the treatment of flexion tendon injury. The process of rehabilitation was carried out for a period of 2 years. Using the Belfast regime as a post-rehabilitation regime ensures no adhesion formation, swelling, or delayed healing.

关键词： Rehabilitation Flexor Injury Zone V early mobilization Belfast Technique

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

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Burns & Trauma 2021年第1期9卷 613-628页

作者： David R.Schieffelers Eric van Breda Nick Gebruers Jill Meirte Ulrike Van Daele Multidisciplinary Metabolic Research Unit(M2RUN) MOVANT Research GroupDepartment of Rehabilitation Sciences and PhysiotherapyFaculty of Medicine and Health SciencesUniversity of AntwerpUniversiteitsplein 12610WilrijkAntwerpBelgium Multidisciplinary Edema Clinic Antwerp University HospitalWilrijkstraat 102650EdegemAntwerpBelgium OSCARE Organisation for burnsscar after-care and researchVan Roiestraat 182170 MerksemAntwerpBelgium

Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of *** the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently *** study aimed to describe the current practice of inpatient rehabilitation across ***:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and *** concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic *** ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic ***:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries *** and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,*** assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and *** all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were *** interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic *** prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status

关键词： Burn care Burn rehabilitation Exercise early mobilization Hypermetabolism Adults

Determination of functional prognosis in hospitalized patients following an intensive care admission

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World Journal of Critical Care Medicine 2016年第4期5卷 219-227页

作者： Natália A Ferreira Agnaldo José Lopes Arthur S Ferreira George Ntoumenopoulos Jerffesson Dias Fernando S Guimaraes Rehabilitation Sciences Post-Gradua-tion Program Augusto Motta University Centre Physical Therapy Department Barra D’Or Hospital Post-Graduation Program in Medical Sciences State University of Rio de Janeiro Graduate School of Health Sciences University of Technology Sydney Physical Therapy Department Federal University of Rio de Janeiro

AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care *** Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).RESULTS Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P < 0.05) were the KATZ and MRC on admission, age, sepsis(no), and total length of stay(TLS). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLS(AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLS(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the Δ*** Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

关键词： Muscle strength Intensive care units Activities of daily living Rehabilitation early mobilization Post-intensive care unit syndrome