외과 중환자 치료의 예후에 조기 재활 프로그램이 미치는 영향

Introduction: Due to the critical care complications like intensive care unit-acquired weakness (ICU-AW), critical illness polyneuropathy (CIP) and neuropsychiatric disease, many organizations focus on rehabilitation. Despite the good results of recent papers, there is debate about method, safety and efficacy of rehabilitation in ICU. We developed an early rehabilitation program (ERP) in our SICU and assessed efficacy of it. Method: The ERP started in November 2014 at the Asan Medical Center surgical ICU. We focused on early and 5-step rehabilitation program for patients admitted to SICU for at least 3 days. The main measures were 28-d ventilator free-days, 28-d ICU free-days, delirium days, hospital length of stay (LOS), adverse events, ICU mortality, in-hospital mortality and 1-year mortality. This trial is registered with ClinicalTrials.gov (NCT03055949). Results: We enrolled 68 patients (pre-ERP group) for 6 months before November 2014 and 61 patients (post-ERP group) for 6 months, 1 year after the ERP started. Rehabilitation of the post-ERP group began on the fourth day of median and was performed for 5.9 days. There were significant increases for the post-ERP group in 28-d ICU free-days (8.8 vs13.6 days, p=0.005), 28-d ventilator free-days (9.7 vs 13.7 days, p=0.035). It was associated with significant positive impacts of in-hospital mortality (26.1 vs 12.9 %, p = 0.046) and 1-year mortality (49.3 vs 29.5 %, p = 0.018), although ICU mortality didn’t show significant difference. There were 18 adverse events (4.9%) in 367 rehabilitation sessions and no further treatment was needed. Conclusion: The ERP can improve long-term outcomes as well as short-term outcomes and be delivered safely.Maste