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Chest. 2013 Nov;144(5):1469-1480. doi: 10.1378/chest.13-0779.

Interventions to improve the physical function of ICU survivors: a systematic review.

Author information

1
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
2
Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Indianapolis, IN. Electronic address: bakhan@iupui.edu.
3
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, and the Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN.
4
Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Indianapolis, IN.

Abstract

BACKGROUND:

ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

METHODS:

MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.

RESULTS:

Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.

CONCLUSIONS:

The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.

PMID:
23949645
PMCID:
PMC3817929
DOI:
10.1378/chest.13-0779
[Indexed for MEDLINE]
Free PMC Article

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