The effect of early mobilization in critically ill patients: A meta‐analysis
Background The aim of this meta‐analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU‐acquired weakness (ICU‐AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality r...
Gespeichert in:
| Veröffentlicht in: | Nursing in critical care 2020-11, Vol.25 (6), p.360-367 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 367 |
|---|---|
| container_issue | 6 |
| container_start_page | 360 |
| container_title | Nursing in critical care |
| container_volume | 25 |
| creator | Zang, Kui Chen, Beibei Wang, Min Chen, Doudou Hui, Liangliang Guo, Shiguang Ji, Ting Shang, Futai |
| description | Background
The aim of this meta‐analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU‐acquired weakness (ICU‐AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate.
Methods
A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed‐effects or random‐effects model according to the heterogeneity among studies.
Results
Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta‐analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU‐AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = −1.82 days, 95% CI: −2.88, −0.76; P = .001) and hospital (WMD = −3.90 days, 95% CI: −5.94, −1.85; P |
| doi_str_mv | 10.1111/nicc.12455 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1111_nicc_12455</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2462830009</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4235-cdd441b2d5876946c422a0dcf261764fe90f64491086772f048c3dd6900771933</originalsourceid><addsrcrecordid>eNqNkc1O3DAUhS1UBBS64QEqS91UrQK-_ovNDkVtQUJ0Q9eRx7GFkRNP40RoWPUReEaepB5myoIFqje27v3uuUfHCB0DOYFyTodg7QlQLsQOOgBeq0qAYO_Km0laAYF6H73P-Y4QSoRge2ifAQVNqT5A1ze3DjvvnZ1w8tiZMa5wnxYhhgczhTTgMGA7hilYE0srxIiXpeGGKZ_hc9y7yTz9eTSDiasc8hHa9SZm92F7H6Jf37_dNBfV1c8fl835VWU5ZaKyXcc5LGgnVC01l6VKDemspxJqyb3TxEvONRAl65p6wpVlXSc1IXUNmrFD9HmjuxzT79nlqe1Dti5GM7g055bSoi8YV6qgn16hd2kei99CcUkVI4ToQn3ZUHZMOY_Ot8sx9GZctUDadcrtOuX2OeUCf9xKzovedS_ov1gL8HUD3LtF8tmWuKx7wcpCoQGUWK8mstDq_-kmTM__0qR5mMoobEdDdKs3PLfXl02zcf8X2VOmGw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2462830009</pqid></control><display><type>article</type><title>The effect of early mobilization in critically ill patients: A meta‐analysis</title><source>Wiley-Blackwell Journals</source><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>Web of Science - Social Sciences Citation Index – 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><creator>Zang, Kui ; Chen, Beibei ; Wang, Min ; Chen, Doudou ; Hui, Liangliang ; Guo, Shiguang ; Ji, Ting ; Shang, Futai</creator><creatorcontrib>Zang, Kui ; Chen, Beibei ; Wang, Min ; Chen, Doudou ; Hui, Liangliang ; Guo, Shiguang ; Ji, Ting ; Shang, Futai</creatorcontrib><description>Background
The aim of this meta‐analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU‐acquired weakness (ICU‐AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate.
Methods
A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed‐effects or random‐effects model according to the heterogeneity among studies.
Results
Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta‐analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU‐AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = −1.82 days, 95% CI: −2.88, −0.76; P = .001) and hospital (WMD = −3.90 days, 95% CI: −5.94, −1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator‐associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: −0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: −0.10, 0.50; P = .194).
Conclusion
This study indicated that early mobilization was effective in preventing the occurrence of ICU‐AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator‐free days.
Relevance to clinical practice
ICU‐AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU‐AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU‐AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate.</description><identifier>ISSN: 1362-1017</identifier><identifier>EISSN: 1478-5153</identifier><identifier>DOI: 10.1111/nicc.12455</identifier><identifier>PMID: 31219229</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Clinical outcomes ; Critical care ; early mobilization ; intensive care unit ; Life Sciences & Biomedicine ; Meta-analysis ; Mobility ; Mortality ; Muscular system ; Nursing ; Recovery (Medical) ; rehabilitation ; Science & Technology ; Ventilators</subject><ispartof>Nursing in critical care, 2020-11, Vol.25 (6), p.360-367</ispartof><rights>2019 British Association of Critical Care Nurses</rights><rights>2019 British Association of Critical Care Nurses.</rights><rights>2020 British Association of Critical Care Nurses</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>100</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000591185300006</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c4235-cdd441b2d5876946c422a0dcf261764fe90f64491086772f048c3dd6900771933</citedby><cites>FETCH-LOGICAL-c4235-cdd441b2d5876946c422a0dcf261764fe90f64491086772f048c3dd6900771933</cites><orcidid>0000-0002-5193-0633</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnicc.12455$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnicc.12455$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,28253,28254,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31219229$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zang, Kui</creatorcontrib><creatorcontrib>Chen, Beibei</creatorcontrib><creatorcontrib>Wang, Min</creatorcontrib><creatorcontrib>Chen, Doudou</creatorcontrib><creatorcontrib>Hui, Liangliang</creatorcontrib><creatorcontrib>Guo, Shiguang</creatorcontrib><creatorcontrib>Ji, Ting</creatorcontrib><creatorcontrib>Shang, Futai</creatorcontrib><title>The effect of early mobilization in critically ill patients: A meta‐analysis</title><title>Nursing in critical care</title><addtitle>NURS CRIT CARE</addtitle><addtitle>Nurs Crit Care</addtitle><description>Background
The aim of this meta‐analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU‐acquired weakness (ICU‐AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate.
Methods
A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed‐effects or random‐effects model according to the heterogeneity among studies.
Results
Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta‐analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU‐AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = −1.82 days, 95% CI: −2.88, −0.76; P = .001) and hospital (WMD = −3.90 days, 95% CI: −5.94, −1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator‐associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: −0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: −0.10, 0.50; P = .194).
Conclusion
This study indicated that early mobilization was effective in preventing the occurrence of ICU‐AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator‐free days.
Relevance to clinical practice
ICU‐AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU‐AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU‐AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate.</description><subject>Clinical outcomes</subject><subject>Critical care</subject><subject>early mobilization</subject><subject>intensive care unit</subject><subject>Life Sciences & Biomedicine</subject><subject>Meta-analysis</subject><subject>Mobility</subject><subject>Mortality</subject><subject>Muscular system</subject><subject>Nursing</subject><subject>Recovery (Medical)</subject><subject>rehabilitation</subject><subject>Science & Technology</subject><subject>Ventilators</subject><issn>1362-1017</issn><issn>1478-5153</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>ARHDP</sourceid><recordid>eNqNkc1O3DAUhS1UBBS64QEqS91UrQK-_ovNDkVtQUJ0Q9eRx7GFkRNP40RoWPUReEaepB5myoIFqje27v3uuUfHCB0DOYFyTodg7QlQLsQOOgBeq0qAYO_Km0laAYF6H73P-Y4QSoRge2ifAQVNqT5A1ze3DjvvnZ1w8tiZMa5wnxYhhgczhTTgMGA7hilYE0srxIiXpeGGKZ_hc9y7yTz9eTSDiasc8hHa9SZm92F7H6Jf37_dNBfV1c8fl835VWU5ZaKyXcc5LGgnVC01l6VKDemspxJqyb3TxEvONRAl65p6wpVlXSc1IXUNmrFD9HmjuxzT79nlqe1Dti5GM7g055bSoi8YV6qgn16hd2kei99CcUkVI4ToQn3ZUHZMOY_Ot8sx9GZctUDadcrtOuX2OeUCf9xKzovedS_ov1gL8HUD3LtF8tmWuKx7wcpCoQGUWK8mstDq_-kmTM__0qR5mMoobEdDdKs3PLfXl02zcf8X2VOmGw</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Zang, Kui</creator><creator>Chen, Beibei</creator><creator>Wang, Min</creator><creator>Chen, Doudou</creator><creator>Hui, Liangliang</creator><creator>Guo, Shiguang</creator><creator>Ji, Ting</creator><creator>Shang, Futai</creator><general>Blackwell Publishing Ltd</general><general>Wiley</general><general>Wiley Subscription Services, Inc</general><scope>17B</scope><scope>AOWDO</scope><scope>ARHDP</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5193-0633</orcidid></search><sort><creationdate>202011</creationdate><title>The effect of early mobilization in critically ill patients: A meta‐analysis</title><author>Zang, Kui ; Chen, Beibei ; Wang, Min ; Chen, Doudou ; Hui, Liangliang ; Guo, Shiguang ; Ji, Ting ; Shang, Futai</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4235-cdd441b2d5876946c422a0dcf261764fe90f64491086772f048c3dd6900771933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Clinical outcomes</topic><topic>Critical care</topic><topic>early mobilization</topic><topic>intensive care unit</topic><topic>Life Sciences & Biomedicine</topic><topic>Meta-analysis</topic><topic>Mobility</topic><topic>Mortality</topic><topic>Muscular system</topic><topic>Nursing</topic><topic>Recovery (Medical)</topic><topic>rehabilitation</topic><topic>Science & Technology</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zang, Kui</creatorcontrib><creatorcontrib>Chen, Beibei</creatorcontrib><creatorcontrib>Wang, Min</creatorcontrib><creatorcontrib>Chen, Doudou</creatorcontrib><creatorcontrib>Hui, Liangliang</creatorcontrib><creatorcontrib>Guo, Shiguang</creatorcontrib><creatorcontrib>Ji, Ting</creatorcontrib><creatorcontrib>Shang, Futai</creatorcontrib><collection>Web of Knowledge</collection><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science - Social Sciences Citation Index – 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Social Sciences Citation Index</collection><collection>Web of Science Primary (SCIE, SSCI & AHCI)</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Nursing in critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zang, Kui</au><au>Chen, Beibei</au><au>Wang, Min</au><au>Chen, Doudou</au><au>Hui, Liangliang</au><au>Guo, Shiguang</au><au>Ji, Ting</au><au>Shang, Futai</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of early mobilization in critically ill patients: A meta‐analysis</atitle><jtitle>Nursing in critical care</jtitle><stitle>NURS CRIT CARE</stitle><addtitle>Nurs Crit Care</addtitle><date>2020-11</date><risdate>2020</risdate><volume>25</volume><issue>6</issue><spage>360</spage><epage>367</epage><pages>360-367</pages><issn>1362-1017</issn><eissn>1478-5153</eissn><abstract>Background
The aim of this meta‐analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU‐acquired weakness (ICU‐AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate.
Methods
A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed‐effects or random‐effects model according to the heterogeneity among studies.
Results
Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta‐analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU‐AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = −1.82 days, 95% CI: −2.88, −0.76; P = .001) and hospital (WMD = −3.90 days, 95% CI: −5.94, −1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator‐associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: −0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: −0.10, 0.50; P = .194).
Conclusion
This study indicated that early mobilization was effective in preventing the occurrence of ICU‐AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator‐free days.
Relevance to clinical practice
ICU‐AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU‐AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU‐AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>31219229</pmid><doi>10.1111/nicc.12455</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5193-0633</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1362-1017 |
| ispartof | Nursing in critical care, 2020-11, Vol.25 (6), p.360-367 |
| issn | 1362-1017 1478-5153 |
| language | eng |
| recordid | cdi_crossref_primary_10_1111_nicc_12455 |
| source | Wiley-Blackwell Journals; Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Web of Science - Social Sciences Citation Index – 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /> |
| subjects | Clinical outcomes Critical care early mobilization intensive care unit Life Sciences & Biomedicine Meta-analysis Mobility Mortality Muscular system Nursing Recovery (Medical) rehabilitation Science & Technology Ventilators |
| title | The effect of early mobilization in critically ill patients: A meta‐analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-13T18%3A05%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20effect%20of%20early%20mobilization%20in%20critically%20ill%20patients:%20A%20meta%E2%80%90analysis&rft.jtitle=Nursing%20in%20critical%20care&rft.au=Zang,%20Kui&rft.date=2020-11&rft.volume=25&rft.issue=6&rft.spage=360&rft.epage=367&rft.pages=360-367&rft.issn=1362-1017&rft.eissn=1478-5153&rft_id=info:doi/10.1111/nicc.12455&rft_dat=%3Cproquest_cross%3E2462830009%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2462830009&rft_id=info:pmid/31219229&rfr_iscdi=true |