Resumen
Objetivo: Conocer el efecto de los programas de movilización progresiva precoz en los resultados de los pacientes críticos.
Métodos: Revisión sistemática utilizando las bases de datos MEDLINE, CINAHL, CENTRAL, PEDro, Clinical Trials.gov, WHO International Clinical Trials Registry Platform y EU Clinical Trials Register. Resultados: Del total de 813 publicaciones identificadas, 18 cumplieron los criterios de inclusión y se incluyeron en esta revisión. Se comprobó que estos programas estaban relacionados con: reducción del tiempo de ventilación, reducción de la duración de la estancia en cuidados intensivos, reducción de la probabilidad de reingreso y aumento de la funcionalidad al alta de cuidados intensivos. Parece haber una tendencia a la reducción de las infecciones y una mayor probabilidad de alta a domicilio. No se encontraron resultados negativos.
Conclusiones: Además de ser seguros, los programas de movilización progresiva precoz parecen aportar importantes beneficios a los pacientes críticos, lo que refuerza la importancia de la intervención en este ámbito.
.
Citas
Ordem Enfermeiros. Guia orientador de boas práticas: Cuidados à pessoa com alterações da mobilidade - posicionamentos, transferências e treino de deambulação [Internet]. Ordem dos Enfermeiros; 2013. Disponível em: https://www.ordemenfermeiros.pt/media/8897/gobp_mobilidade_vf_site.pdf
Machado J, Castro M, Ceniccola G, Giacomassi I, Isola A, Silva Jr J, et al. Bundles do combate à fraqueza adquirida na unidade de terapia intensiva. BRASPEN J. 2021;36(2):131–75.
Voiriot G, Oualha M, Pierre A, Salmon-Gandonnière C, Gaudet A, Jouan Y, et al. Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges. Annals of Intensive Care. 2022;12(1):1–14. Disponível em: https://doi.org/10.1186/s13613-022-01038-0
Davidson J, Harvey M, Achuller J, Black G. Post-intensive care syndrome: what it is and how to help prevent it. Am Nurse Today. 2013;8(5):32–8.
Svenningsen H, Langhorn L, Ågård AS, Dreyer P. Post-ICU symptoms, consequences, and follow-up: an integrative review. Nurs Crit Care. 2017;22(4):212–20. Disponível em: https://doi.org/10.1111/nicc.12165
Rawal G, Yadav S, Kumar R. Post-intensive care syndrome: an overview. J Transl Int Med. 2017;5(2):90–2. Disponível em: https://doi.org/10.1515/jtim-2016-0016
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in critical care. Crit Care Clin. 2017;33(2):225–43. Disponível em: https://doi.org/10.1016/j.ccc.2016.12.005
Pandharipande P, Banerjee A, McGrane S, EW E, Pandharipande P, Banerjee A, et al. Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care. Crit Care. 2010;14(3):157. Disponível em: https://doi.org/10.1186/cc8999
Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Medicine. 2008; 34(7):1188–99. Disponível em: https://doi.org/10.1007/s00134-008-1026-7
Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, et al. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders?: Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist]. 2015;64 Suppl 1:1–26. Disponível em: https://doi.org/10.1007/s00101-015-0071-1
Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: Systematic review and meta-Analysis. PLoS One. 2015;10(7):e0130722. Disponível em: https://doi.org/10.1371/journal.pone.0130722
Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018;3(3):CD010754. Disponível em: https://doi.org/10.1002/14651858.CD010754.pub2
da Silva Pissolato J, Fleck CS. Mobilização precoce na unidade de terapia intensiva adulta. Fisioterapia Brasil. 2018;19(3):377–84. Disponível em: https://doi.org/10.33233/fb.v19i3.690
Okada Y, Unoki T, Matsuishi Y, Egawa Y, Hayashida K, Inoue S. Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: A systematic review and meta-analysis. J Intensive Care. 2019;7(1). Disponível em: https://doi.org/10.1186/s40560-019-0413-1
Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019;14(10). Disponível em: https://doi.org/10.1371/journal.pone.0223185
Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262. Disponível em: http://dx.doi.org/10.1136/bmjopen-2013-003262
Berry A, Beattie K, Bennett J, Cross CW, Cushway S, Hassan A, et al. Intensive Care NSW-Physical activity and movement-A guideline for critically ill adults: a Guideline for Critically Ill Adults [Internet]. Chatswood: Agency for Clinical Innovation; 2017 (Citado em: 2023 Abril 1). Disponível em: https://aci.health.nsw.gov.au/__data/assets/pdf_file/0005/239783/ACI-Physical-activity-movement-guideline-critically-ill-adults.pdf
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (atualizado em 2022 Fev). Cochrane, 2022. Disponível em: www.training.cochrane.org/handbook
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ (Online). 2009;339:b2535. Disponível em: https://doi.org/10.1136/bmj.b2535
Azuh O, Gammon H, Burmeister C, Frega D, Nerenz D, DiGiovine B, et al. Benefits of early active mobility in the medical intensive care unit: A pilot study. American Journal of Medicine. 2016;129(8):866-871.e1. Disponível em: http://dx.doi.org/10.1016/j.amjmed.2016.03.032
Bahouth MN, Power MC, Zink EK, Kozeniewski K, Kumble S, Deluzio S, et al. Safety and feasibility of a neuroscience critical care program to mobilize patients with primary intracerebral hemorrhage. Arch Phys Med Rehabil. 2018;99(6):1220–5. Disponível em: https://doi.org/10.1016/j.apmr.2018.01.034
Booth K, Rivet J, Flici R, Harvey E, Hamill M, Hundley D, et al. Progressive mobility protocol reduces venous thromboembolism rate in trauma intensive care patients: A quality improvement project. J Trauma Nurs. 2016;23(5):284–9. Disponível em: https://doi.org/10.1097/JTN.0000000000000234
Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: A retrospective cohort study. Phys Ther. 2013;93(2):186–96. Disponível em: https://doi.org/10.2522/ptj.20110417
Crane AN. Implementing an early mobility protocol for patients in the Intensive care unit [Internet]. Dissertation – Doctor Nursing Practice. Brandman University Irvine, California. Disponível em: http://hdl.handle.net/10755/20635
Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013 Jan;36(1):127–40. Disponível em: https://doi.org/10.1097/CNQ.0b013e31827538a1
Floyd S, Craig SW, Topley D, Tullmann D. Evaluation of a progressive mobility protocol in postoperative cardiothoracic surgical patients. Dimens Crit Care Nurs. 2016;35(5):277–82. Disponível em: https://doi.org/10.1097/DCC.0000000000000197
Fraser D, Spiva L, Forman W, Hallen C. Implementation of an early mobility program in an ICU. Am J Nurs. 2015;115(12):49–58. Disponível em: https://doi.org/10.1097/01.NAJ.0000475292.27985.fc
Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, et al. A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Crit Care Med. 2016;44(6):1145–52. Disponível em: https://doi.org/10.1097/CCM.0000000000001643
Klein K, Mulkey M, Bena JFJF, Albert NM. Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study. Crit Care Med. 2015;43(4):865–73. Disponível em: https://doi.org/10.1097/CCM.0000000000000787
Lai CC, Chou W, Chan KS, Cheng KC, Yuan KS, Chao CM, et al. Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Arch Phys Med Rehabil. 2017;98(5):931–9. Disponível em: https://doi.org/10.1016/j.apmr.2016.11.007
Liu K, Ogura T, Takahashi K, Nakamura M, Ohtake H, Fujiduka K, et al. A progressive early mobilization program is significantly associated with clinical and economic improvement: A single-center quality comparison study. Crit Care Med. 2019;47(9):e744–52. Disponível em: https://doi.org/10.1097/CCM.0000000000003850
Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: Who stands to win? Am J Surg. 2013 Oct;206(4):488–93. Disponível em: https://doi.org/10.1016/j.amjsurg.2013.03.001
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43. Disponível em: https://doi.org/10.1097/CCM.0b013e318180b90e
Ronnebaum J, Weir J, Ronnebaum JA, Weir JP, Hilsabeck TA. Earlier mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy 3(2):204-210.
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. The Lancet. 2016;388(10052):1377–88. Disponível em: https://doi.org/10.1016/S0140-6736(16)31637-3
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(9678):1874-1882. Disponível em: https://doi.org/10.1016/S0140-6736(09)60658-9
Winkelman C, Johnson KD, Hejal R, Gordon NH, Rowbottom J, Daly J, et al. Examining the positive effects of exercise in intubated adults in ICU: a prospective repeated measures clinical study. Intensive Crit Care Nurs. 2012;28(6):307–18. Disponível em: https://doi.org/10.1016/j.iccn.2012.02.007
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses [Internet]. [citado 2023 Abril 1]. Disponível em: https://www.ohri.ca//programs/clinical_epidemiology/oxford.asp
Higins J, Savovic J, Page M, Elbers R, Sterne J. Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (atualizado em 2022 Fev). Cochrane, 2022. Disponível em: https://training.cochrane.org/handbook/current/chapter-08
Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658. Disponível em: https://doi.org/10.1186/s13054-014-0658-y
Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020;107:1–10. Disponível em: https://doi.org/10.1016/j.physio.2019.12.004
Wang J, Ren D, Liu Y, Wang Y, Zhang B, Xiao Q. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020;110:103708. Disponível em: https://doi.org/10.1016/j.ijnurstu.2020.103708
Zayed Y, Kheiri B, Barbarawi M, Chahine A, Rashdan L, Chintalapati S, et al. Effects of neuromuscular electrical stimulation in critically ill patients: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2019 33(2):203-210. Disponível em: https://doi.org/10.1016/j.aucc.2019.04.003
Chen B, Xie G, Lin Y, Chen L, Lin Z, You X, et al. A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery. Medicine. 2021;100(15):e25314. Disponível em: https://doi.org/10.1097/MD.0000000000018843
Zang K, Chen B, Wang M, Chen D, Hui L, Guo S, et al. The effect of early mobilization in critically ill patients: A meta-analysis. Nurs Crit Care. 2020;25(6):360-367. Disponível em: https://doi.org/10.1111/nicc.12455
Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med. 2021;42(1):112–26. Disponível em: https://doi.org/10.1055/s-0040-1710572
Dirkes SM, Kozlowski C. Early mobility in the intensive care unit: Evidence, barriers, and future directions. Crit Care Nurse. 2019;39(3):33–42. Disponível em: https://doi.org/10.4037/ccn2019654
Harrold ME, Salisbury LG, Webb SA, Allison GT, Australia and Scotland ICU Physiotherapy Collaboration. Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care. 2015;19(1):336. Disponível em: https://doi.org/10.1186/s13054-015-1033-3
Leditschke A, Green M, Irvine J, Bissett B, Mitchell IA. What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012;23(1):26–9.
Esteban AR, Espejo J, Estrera-Portal R, Plummer BJ. Unit-based early progressive mobility champion. Crit Care Nurse. 2014;34(2):e7–e7.
Bruce R. Integrating a mobility champion in the intensive care unit. Dimens Crit Care Nurs. 2018;37(4):201-209. Disponível em: https://doi.org/10.1097/DCC.0000000000000306
Mendes R, Nunes L, Pinho JA, Gonçalves R. Organização dos cuidados de reabilitação nas unidades de cuidados intensivos portuguesas. Rev Bras Ter Intensiva. 2018;30(1):57–63. Disponível em: https://doi.org/10.5935/0103-507X.20180011
Mendes R, Nunes M. A importância da enfermagem de reabilitação nas unidades de cuidados intensivos portuguesas. Rev Port Enf Reab. 2018;1(2):8–13. Disponível em: https://doi.org/10.33194/rper.2018.v1.n2.01.4406
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Derechos de autor 2023 Revista Portuguesa de Enfermería de Rehabilitación
Descargas
Consultas del resumen | 405 |
---|
PDF (Português (Portugal)) | 317 |
---|
PDF (English) | 22 |
---|