重症患者のリハビリテーション

重症患者に対するリハビリテーションの目的は，日常生活活動（activities of daily living, ADL）を維持，改善，再獲得することで，QOLを改善することである。重症患者に対するリハビリテーションはABCDEFバンドルの一つの要素として捉え，集中治療後症候群ost-intensive care syndrome, PICS）予防のために包括的な介入を行うべきである。重症患者においてリハビリテーションは死亡を改善しないが，身体機能やADLを改善するため，国内外のガイドラインで実施が推奨されている。近年はPICS予防のためのICU入室中のリハビリテーションだけでなく，ICU退室...

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Published in日本集中治療医学会雑誌 Vol. 29; no. 5; pp. 503 - 509
Main Author 對東, 俊介
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本集中治療医学会 01.09.2022
Online AccessGet full text
ISSN1340-7988
1882-966X
DOI10.3918/jsicm.29_503

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Abstract 重症患者に対するリハビリテーションの目的は，日常生活活動（activities of daily living, ADL）を維持，改善，再獲得することで，QOLを改善することである。重症患者に対するリハビリテーションはABCDEFバンドルの一つの要素として捉え，集中治療後症候群ost-intensive care syndrome, PICS）予防のために包括的な介入を行うべきである。重症患者においてリハビリテーションは死亡を改善しないが，身体機能やADLを改善するため，国内外のガイドラインで実施が推奨されている。近年はPICS予防のためのICU入室中のリハビリテーションだけでなく，ICU退室後のリハビリテーションやフォローアップが注目されている。臨床現場で遭遇する様々な障害や疾患に対するICU内およびICU退院後のリハビリテーションの最適な量，頻度，強度，期間，および種類を明らかにするために，さらなる研究が必要である。
AbstractList 重症患者に対するリハビリテーションの目的は，日常生活活動（activities of daily living, ADL）を維持，改善，再獲得することで，QOLを改善することである。重症患者に対するリハビリテーションはABCDEFバンドルの一つの要素として捉え，集中治療後症候群ost-intensive care syndrome, PICS）予防のために包括的な介入を行うべきである。重症患者においてリハビリテーションは死亡を改善しないが，身体機能やADLを改善するため，国内外のガイドラインで実施が推奨されている。近年はPICS予防のためのICU入室中のリハビリテーションだけでなく，ICU退室後のリハビリテーションやフォローアップが注目されている。臨床現場で遭遇する様々な障害や疾患に対するICU内およびICU退院後のリハビリテーションの最適な量，頻度，強度，期間，および種類を明らかにするために，さらなる研究が必要である。
Author 對東, 俊介
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References 40) Tipping CJ, Harrold M, Holland A, et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 2017;43:171-83.
39) Lang JK, Paykel MS, Haines KJ, et al. Clinical Practice Guidelines for Early Mobilization in the ICU: A Systematic Review. Crit Care Med 2020;48:e1121-8.
37) Girard TD, Alhazzani W, Kress JP, et al; ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med 2017;195:120-33.
12) Inoue S, Hatakeyama J, Kondo Y, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019;6:233-46.
45) Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, et al.Feasibility of a home-based interdisciplinary rehabilitationprogram for patients with Post-Intensive Care Syndrome:the REACH study. Crit Care 2021;25:279.
3) 日本集中治療医学会集中治療早期リハビリテーション委員会．集中治療室におけるリハビリテーション実態調査．日集中医誌 2020;27:45-51.
13) Hodgson CL, Turnbull AE, Iwashyna TJ, et al. Core Domains in Evaluating Patient Outcomes After Acute Respiratory Failure: International Multidisciplinary Clinician Consultation. Phys Ther 2017;97:168-74.
19) Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018;46:e825-73.
49) Wang YT, Lang JK, Haines KJ, et al. Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2022;50:375-88.
24) Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017;43:531-42.
17) Hermans G, Van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit- acquired weakness. A cohort study and propensitymatched analysis. Am J Respir Crit Care Med 2014;190: 410-20.
6) 對東俊介，志馬伸朗．身体リハビリテーション―PICSの予防に有効か? ．INTENSIVIST 2018;10:119-28.
33) Bein T, Bischoff M, Brückner U, 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.
47) Fossat G, Baudin F, Courtes L, et al. Effect of In-Bed LegCycling and Electrical Stimulation of the Quadriceps onGlobal Muscle Strength in Critically Ill Adults: ARandomized Clinical Trial. JAMA 2018;320:368-78.
50) Ding N, Zhang Z, Zhang C, et al. What is the optimumtime for initiation of early mobilization in mechanicallyventilated patients? A network meta-analysis. PLoS One2019;14:e0223151.
2) 日本集中治療医学会早期リハビリテーション検討委員会．集中治療における早期リハビリテーション～根拠に基づくエ キスパートコンセンサス～．日集中医誌 2017;24:255-303.
36) Agency for Clinical Innovation（ACI）. Physical Activity and Movement: A Guideline for Critically Ill Adults. 2017. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/239783/ACI17131_PAM_Guideline.pdf（2022年1月20日閲覧）
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42) Connolly B, Salisbury L, O’Neill B, et al; ERACIP Group. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev 2015;2015:CD008632.
10) Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009;37:2499-505.
25) Bakhru RN, Wiebe DJ, McWilliams DJ, et al. An Environmental Scan for Early Mobilization Practices in U.S. ICUs. Crit Care Med 2015;43:2360-9.
30) Berney S, Hopkins RO, Rose JW, et al. Functional electrical stimulation in-bed cycle ergometry in mechani cally ventilated patients: a multicentre randomised controlled trial. Thorax 2021;76:656-63.
16) Fan E, Dowdy DW, Colantuoni E, et al. Physical complications in acute lung injury survivors: a two-year longitu dinal prospective study. Crit Care Med 2014;42:849-59.
32) National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults. 2009. Available from: https://www.nice.org.uk/guidance/CG83（2022年1月20日閲覧）
26) Miller MA, Govindan S, Watson SR, et al. ABCDE, but in that order? A cross-sectional survey of Michigan intensive care unit sedation, delirium, and early mobility practices. Ann Am Thorac Soc 2015;12:1066-71.
35) Murray MJ, DeBlock H, Erstad B, et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med 2016;44:2079-103.
18) Naidech AM, Beaumont JL, Rosenberg NF, et al. Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. Am J Respir Crit Care Med 2013;188:1331-7.
48) Schweickert WD, Pohlman MC, Pohlman AS, et al. Earlyphysical and occupational therapy in mechanically ventilated,critically ill patients: a randomised controlled trial.Lancet 2009;373:1874-82.
8) Schaller SJ, Anstey M, Blobner M, et al; International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016;388:1377-88.
7) Taito S, Shime N, Ota K, et al. Early mobilization of mechanically ventilated patients in the intensive care unit. J Intensive Care 2016;4:50.
9) Hodgson CL, Bailey M, Bellomo R, et al; Trial of Early Activity and Mobilization Study Investigators. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med 2016;44:1145-52.
1) Taito S, Sanui M, Yasuda H, et al; Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. J Intensive Care 2016;4:66.
23) Connolly BA, Mortimore JL, Douiri A, et al. Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap. J Intensive Care Med 2019;34:818-27.
5) Hodgson CL, Udy AA, Bailey M, et al. The impact of disability in survivors of critical illness. Intensive Care Med 2017;43:992-1001.
20) Barnes-Daly MA, Phillips G, Ely EW. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. Crit Care Med 2017;45:171-8.
38) Aquim EE, Bernardo WM, Buzzini RF, et al. Brazilian Guidelines for Early Mobilization in Intensive Care Unit. Rev Bras Ter Intensiva 2019;31:434-43.
14) Dinglas VD, Chessare CM, Davis WE, et al. Perspectives of survivors, families and researchers on key outcomes for research in acute respiratory failure. Thorax 2018;73:7-12.
11) Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012;40:502-9.
22) Berney SC, Rose JW, Bernhardt J, et al. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care 2015;30:658-63.
46) Parker A, Tehranchi KM, Needham DM. Critical carerehabilitation trials: the importance of ‘usual care’. CritCare 2013;17:183.
28) Guérin C, Reignier J, Richard JC, et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.
51) Menges D, Seiler B, Tomonaga Y, et al. Systematic earlyversus late mobilization or standard early mobilization inmechanically ventilated adult ICU patients: systematicreview and meta-analysis. Crit Care 2021;25:16.
15) Kawakami D, Fujitani S, Morimoto T, et al. Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study. Crit Care 2021;25:69.
27) Hodgson CL, Capell E, Tipping CJ. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice. Crit Care 2018;22:77.
34) Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the intensive care unit: an evidencebased, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29:1051-63.
43) Taito S, Yamauchi K, Tsujimoto Y, et al. Does enhancedphysical rehabilitation following intensive care unitdischarge improve outcomes in patients who receivedmechanical ventilation? A systematic review and metaanalysis.BMJ Open 2019;9:e026075.
44) Rosa RG, Ferreira GE, Viola TW, et al. Effects of post-ICUfollow-up on subject outcomes: A systematic review andmeta-analysis. J Crit Care 2019;52:115-25.
41) Scheffenbichler FT, Teja B, Wongtangman K, et al. Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study. Crit Care Med 2021;49:e247-57.
21) Pun BT, Balas MC, Barnes-Daly MA, et al. Caring f
References_xml – reference: 2) 日本集中治療医学会早期リハビリテーション検討委員会．集中治療における早期リハビリテーション～根拠に基づくエ キスパートコンセンサス～．日集中医誌 2017;24:255-303.
– reference: 15) Kawakami D, Fujitani S, Morimoto T, et al. Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study. Crit Care 2021;25:69.
– reference: 25) Bakhru RN, Wiebe DJ, McWilliams DJ, et al. An Environmental Scan for Early Mobilization Practices in U.S. ICUs. Crit Care Med 2015;43:2360-9.
– reference: 47) Fossat G, Baudin F, Courtes L, et al. Effect of In-Bed LegCycling and Electrical Stimulation of the Quadriceps onGlobal Muscle Strength in Critically Ill Adults: ARandomized Clinical Trial. JAMA 2018;320:368-78.
– reference: 3) 日本集中治療医学会集中治療早期リハビリテーション委員会．集中治療室におけるリハビリテーション実態調査．日集中医誌 2020;27:45-51.
– reference: 36) Agency for Clinical Innovation（ACI）. Physical Activity and Movement: A Guideline for Critically Ill Adults. 2017. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/239783/ACI17131_PAM_Guideline.pdf（2022年1月20日閲覧）
– reference: 43) Taito S, Yamauchi K, Tsujimoto Y, et al. Does enhancedphysical rehabilitation following intensive care unitdischarge improve outcomes in patients who receivedmechanical ventilation? A systematic review and metaanalysis.BMJ Open 2019;9:e026075.
– reference: 35) Murray MJ, DeBlock H, Erstad B, et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med 2016;44:2079-103.
– reference: 39) Lang JK, Paykel MS, Haines KJ, et al. Clinical Practice Guidelines for Early Mobilization in the ICU: A Systematic Review. Crit Care Med 2020;48:e1121-8.
– reference: 34) Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the intensive care unit: an evidencebased, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29:1051-63.
– reference: 12) Inoue S, Hatakeyama J, Kondo Y, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019;6:233-46.
– reference: 33) Bein T, Bischoff M, Brückner U, 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.
– reference: 40) Tipping CJ, Harrold M, Holland A, et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 2017;43:171-83.
– reference: 37) Girard TD, Alhazzani W, Kress JP, et al; ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med 2017;195:120-33.
– reference: 19) Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018;46:e825-73.
– reference: 11) Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012;40:502-9.
– reference: 16) Fan E, Dowdy DW, Colantuoni E, et al. Physical complications in acute lung injury survivors: a two-year longitu dinal prospective study. Crit Care Med 2014;42:849-59.
– reference: 51) Menges D, Seiler B, Tomonaga Y, et al. Systematic earlyversus late mobilization or standard early mobilization inmechanically ventilated adult ICU patients: systematicreview and meta-analysis. Crit Care 2021;25:16.
– reference: 1) Taito S, Sanui M, Yasuda H, et al; Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. J Intensive Care 2016;4:66.
– reference: 49) Wang YT, Lang JK, Haines KJ, et al. Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2022;50:375-88.
– reference: 6) 對東俊介，志馬伸朗．身体リハビリテーション―PICSの予防に有効か? ．INTENSIVIST 2018;10:119-28.
– reference: 50) Ding N, Zhang Z, Zhang C, et al. What is the optimumtime for initiation of early mobilization in mechanicallyventilated patients? A network meta-analysis. PLoS One2019;14:e0223151.
– reference: 42) Connolly B, Salisbury L, O’Neill B, et al; ERACIP Group. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev 2015;2015:CD008632.
– reference: 31) Waldauf P, Jiroutková K, Krajčová A, et al. Effects of Rehabilitation Interventions on Clinical Outcomes in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit Care Med 2020;48:1055-65.
– reference: 46) Parker A, Tehranchi KM, Needham DM. Critical carerehabilitation trials: the importance of ‘usual care’. CritCare 2013;17:183.
– reference: 26) Miller MA, Govindan S, Watson SR, et al. ABCDE, but in that order? A cross-sectional survey of Michigan intensive care unit sedation, delirium, and early mobility practices. Ann Am Thorac Soc 2015;12:1066-71.
– reference: 32) National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults. 2009. Available from: https://www.nice.org.uk/guidance/CG83（2022年1月20日閲覧）
– reference: 10) Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009;37:2499-505.
– reference: 48) Schweickert WD, Pohlman MC, Pohlman AS, et al. Earlyphysical and occupational therapy in mechanically ventilated,critically ill patients: a randomised controlled trial.Lancet 2009;373:1874-82.
– reference: 17) Hermans G, Van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit- acquired weakness. A cohort study and propensitymatched analysis. Am J Respir Crit Care Med 2014;190: 410-20.
– reference: 8) Schaller SJ, Anstey M, Blobner M, et al; International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016;388:1377-88.
– reference: 7) Taito S, Shime N, Ota K, et al. Early mobilization of mechanically ventilated patients in the intensive care unit. J Intensive Care 2016;4:50.
– reference: 27) Hodgson CL, Capell E, Tipping CJ. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice. Crit Care 2018;22:77.
– reference: 30) Berney S, Hopkins RO, Rose JW, et al. Functional electrical stimulation in-bed cycle ergometry in mechani cally ventilated patients: a multicentre randomised controlled trial. Thorax 2021;76:656-63.
– reference: 18) Naidech AM, Beaumont JL, Rosenberg NF, et al. Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. Am J Respir Crit Care Med 2013;188:1331-7.
– reference: 41) Scheffenbichler FT, Teja B, Wongtangman K, et al. Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study. Crit Care Med 2021;49:e247-57.
– reference: 24) Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017;43:531-42.
– reference: 5) Hodgson CL, Udy AA, Bailey M, et al. The impact of disability in survivors of critical illness. Intensive Care Med 2017;43:992-1001.
– reference: 9) Hodgson CL, Bailey M, Bellomo R, et al; Trial of Early Activity and Mobilization Study Investigators. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med 2016;44:1145-52.
– reference: 13) Hodgson CL, Turnbull AE, Iwashyna TJ, et al. Core Domains in Evaluating Patient Outcomes After Acute Respiratory Failure: International Multidisciplinary Clinician Consultation. Phys Ther 2017;97:168-74.
– reference: 38) Aquim EE, Bernardo WM, Buzzini RF, et al. Brazilian Guidelines for Early Mobilization in Intensive Care Unit. Rev Bras Ter Intensiva 2019;31:434-43.
– reference: 20) Barnes-Daly MA, Phillips G, Ely EW. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. Crit Care Med 2017;45:171-8.
– reference: 21) Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Crit Care Med 2019;47:3-14.
– reference: 14) Dinglas VD, Chessare CM, Davis WE, et al. Perspectives of survivors, families and researchers on key outcomes for research in acute respiratory failure. Thorax 2018;73:7-12.
– reference: 44) Rosa RG, Ferreira GE, Viola TW, et al. Effects of post-ICUfollow-up on subject outcomes: A systematic review andmeta-analysis. J Crit Care 2019;52:115-25.
– reference: 45) Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, et al.Feasibility of a home-based interdisciplinary rehabilitationprogram for patients with Post-Intensive Care Syndrome:the REACH study. Crit Care 2021;25:279.
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Snippet 重症患者に対するリハビリテーションの目的は，日常生活活動（activities of daily living, ADL）を維持，改善，再獲得することで，QOLを改善することである。重症患者に...
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Title 重症患者のリハビリテーション
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ispartofPNX 日本集中治療医学会雑誌, 2022/09/01, Vol.29(5), pp.503-509
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