Objective: To determine the safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit (ICU) by systematic review.
Methods: Randomized controlled trails (RCTs) and cohort studies about early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in ICU were retrieved in CBM, CNKI, Wanfang Data, PubMed, Cochrane Library and Web of Science from their foundation to March 2018, and other sources as supplement was also retrieved. The intervention program of RCT study was ICU routine nursing in control group, early activity in observation group, and early activity in cohort study without control group. Early activities included active and passive activities on the bed, sitting upright, bed-chair transfer, standing and walking. Literature screening and data extraction were performed independently by two researchers. Variables or parameters related to cardiovascular, respiratory, nervous, orthopedic and other systems were collected for safety criteria. Variables or parameters used in at least three literatures were collected for each system. Cochrane 5.1.0 was used to evaluate the quality of RCT study, and Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort study.
Results: A total of 24 articles about early activity of patients undergoing mechanical ventilation in ICU were enrolled, involving 4 647 patients, including 11 RCT studies involving 1 031 patients, 509 in control group and 522 in observation group; 13 cohort studies including 3 616 patients. It was shown by systematic review that safety criteria for early activity in patients undergoing mechanical ventilation in ICU involved five systems, 20 variables or parameters. The cardiovascular system included 8 variables or parameters, such as 40 bpm < heart rate (HR) < 130 bpm (n = 4), hemodynamic stability (n = 5), no myocardial infarction (n = 3), no arrhythmia (n = 4), no vascular active drugs (n = 4), 90 mmHg < systolic blood pressure (SBP) < 200 mmHg (1 mmHg = 0.133 kPa, n = 4), 65 mmHg ≤ mean arterial pressure (MAP) ≤ 110 mmHg (n = 3), no history of cardiopulmonary resuscitation (CPR, n = 5). The respiratory system included 4 variables or parameters, involving 5 times/min < respiratory rate (RR) < 40 times/min (n = 5), fraction of inspired oxygen (FiO2) ≤ 0.60 and positive end-expiratory pressure (PEEP) ≤ 10 cmH2O (1 cmH2O = 0.098 kPa, n = 4), FiO2 < 0.60 or PEEP < 10 cmH2O (n = 3), pulse blood oxygenation (SpO2) > 0.88 (n = 5). The nervous system included 4 variables, including no neuromuscular disease (n = 7), no increase in intracranial pressure (n = 7), no coma (n = 4), understand and do the right thing (n = 4). The orthopedic system included 2 variables, including no fracture (n = 3), no unstable fracture (n = 8). Other factors included 2 variables, including no open abdomen wound (n = 4), and no palliative care (n = 3).
Conclusions: This study identified safety criteria for early goal-directed rehabilition exercise in patients undergoing mechanical ventilation in ICU included five systems of cardiovascular, respiratory, neurological, orthopedic, and other systems, in which cardiovascular and respiratory systems were the most frequently cited variables or parameters. The consistency of each system security criteria or variables reported by different literatures was high, but the parameters need to be further verified by high-quality study.