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      Early rehabilitation for the prevention of postintensive care syndrome in critically ill patients: a study protocol for a systematic review and meta-analysis

      protocol

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          Abstract

          Introduction

          Postintensive care syndrome (PICS) is defined as a new or worsening impairment in cognition, mental health and physical function after critical illness. There is little evidence regarding treatment of patients with PICS; new directions for effective treatment strategies are urgently needed. Early physiotherapy may prevent or reverse some physical impairments in patients with PICS, but no systematic reviews have investigated the effectiveness of early rehabilitation on PICS-related outcomes. The purpose of this systematic review is to evaluate whether early rehabilitative interventions in critically ill patients can prevent PICS and decrease mortality.

          Methods

          We will conduct a systematic review and meta-analysis of early rehabilitation for the prevention of PICS in critically ill adults. We will search PubMed, EMBASE and the Cochrane Central Register of Controlled Trials for published randomised controlled trials. We will screen search results and assess study selection, data extraction and risk of bias in duplicate, resolving disagreements by consensus. We will pool data from clinically homogeneous studies using a random-effects meta-analysis; assess heterogeneity of effects using the χ 2 test of homogeneity; and quantify any observed heterogeneity using the I 2 statistic. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence.

          Discussion

          This systematic review will present evidence on the prevention of PICS in critically ill patients with early rehabilitation.

          Ethics

          Ethics approval is not required.

          Dissemination

          The results will be disseminated via peer-reviewed journal publication, conference presentation(s) and publications for patient information.

          Trial registration number

          CRD42016039759.

          Related collections

          Most cited references42

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          Post-hospital syndrome--an acquired, transient condition of generalized risk.

          Harlan M. Krumholz (2013)
          Article 0 comments Cited 340 times – based on 0 reviews     Review now
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            Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

            Peter Morris, Amanda Goad, Clifton C. Thompson … (2008)
            Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.
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              Long-term complications of critical care.

              Sanjay V Desai, Tyler Law, Dale M Needham (2011)
              As critical care advances and intensive care unit mortality declines, the number of survivors of critical illness is increasing. These survivors frequently experience long-lasting complications of critical care. As a result, it is important to understand these complications and implement evidence-based practices to minimize them. Database searches and review of relevant medical literature. Critical illness and intensive care unit care influence a wide range of long-term patient outcomes, with some impairments persisting for 5-15 yrs. Impaired pulmonary function, greater healthcare utilization, and increased mortality are observed in intensive care survivors. Neuromuscular weakness and impairments in both physical function and related aspects of quality of life are common and may be long-lasting. These complications may be reduced by multidisciplinary physical rehabilitation initiated early and continued throughout the intensive care unit care stay and by providing patient education for self-rehabilitation after hospital discharge. Common neuropsychiatric complications, including cognitive impairment and symptoms of depression and posttraumatic stress disorder, are frequently associated with intensive care unit sedation, delirium or delusional memories, and long-term impairments in quality of life. Survivors of critical illness are frequently left with a legacy of long-term physical, neuropsychiatric, and quality of life impairments. Understanding patient and intensive care risk factors can help identify patients who are most at risk of these complications. Furthermore, modifiable risk factors and beneficial interventions are increasingly being identified to help inform practical management recommendations to reduce the prevalence and impact of these long-term complications.
              Article 0 comments Cited 251 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2017
                Publication date (Electronic): 1 March 2017
                Volume: 7
                Issue: 3
                Electronic Location Identifier: e013828
                Affiliations
                [1 ]Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus , Nakagami-gun, Japan
                [2 ]Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University , Sendai city, Japan
                [3 ]Emergency Medical Center, Kagawa University Hospital , Kita-gun-Takamatsu, Japan
                [4 ]Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital , Yokohama city, Japan
                [5 ]Division of Trauma and Surgical Critical Care, Osaka General Medical Center , Osaka city, Japan
                [6 ]Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital , Hachioji, Tokyo, Japan
                [7 ]Department of Anaesthesiology and Critical Care Medicine, Fujita Health University School of Medicine , Toyoake City, Japan
                Author notes
                [Correspondence to ] Dr Shigeaki Inoue; sg-inoue@ 123456is.icc.u-tokai.ac.jp
                Article
                Publisher ID: bmjopen-2016-013828
                DOI: 10.1136/bmjopen-2016-013828
                PMC ID: 5353352
                PubMed ID: 28249850
                SO-VID: 127ee308-7ac2-483c-b17a-7297a9823d39
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 9 August 2016
                Date revision received : 10 February 2017
                Date accepted : 13 February 2017
                Categories
                Subject: Intensive Care
                Subject: Protocol
                Subject: 1506
                Subject: 1707
                Subject: 1706

                ScienceOpen disciplines: Medicine
                Keywords: post-intensive care syndrome,early rehabilitation,sepsis
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: post-intensive care syndrome, early rehabilitation, sepsis

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