2023+JSICM临床实践指南：危重患者康复（英文版）.pdf

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1、Unokietal.Journal of Intensive Care https:/doi.org/10.1186/s40560-023-00697-wREVIEWOpen Access The Author(s)2023.Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use,sharing,adaptation,distribution and reproduction in any medium or for

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5、tice Guidelines forRehabilitation inCritically Ill Patients 2023(J-ReCIP 2023)Takeshi Unoki1*,Kei Hayashida2,Yusuke Kawai3,Shunsuke Taito4,Morihide Ando5,Yuki Iida6,Fumihito Kasai7,Tatsuya Kawasaki8,Ryo Kozu9,72,Yutaka Kondo10,Masakazu Saitoh11,Hideaki Sakuramoto12,Nobuyuki Sasaki13,Ryuichi Saura14,

6、Kensuke Nakamura15,Akira Ouchi16,Saiko Okamoto17,Masatsugu Okamura18,Tomoki Kuribara1,Akira Kuriyama19,Yujiro Matsuishi20,Norimasa Yamamoto21,Shodai Yoshihiro22,Taisuke Yasaka23,Ryo Abe24,Takahito Iitsuka25,Hiroyasu Inoue26,Yuki Uchiyama27,Satoshi Endo28,Kazuki Okura29,Kohei Ota30,Takahisa Otsuka31,

7、Daisuke Okada32,Kengo Obata33,Yukiko Katayama34,Naoki Kaneda35,Mio Kitayama36,Shunsuke Kina37,Ryuichi Kusaba38,Masanari Kuwabara39,Naoki Sasanuma40,Masahiro Takahashi41,Chihiro Takayama42,Naonori Tashiro43,Junko Tatsuno44,Takahiko Tamura45,Mitsuhiro Tamoto46,Asuka Tsuchiya47,Yusuke Tsutsumi48,Tadash

8、i Nagato49,Chihiro Narita50,Tomohiro Nawa51,Tadayoshi Nonoyama52,Masatoshi Hanada9,Kotaro Hirakawa53,Akiko Makino20,Hirotaka Masaki54,Ryosuke Matsuki55,Shinya Matsushima56,Wataru Matsuda57,Saori Miyagishima58,Masaru Moromizato59,Naoya Yanagi60,Kota Yamauchi61,Yuhei Yamashita62,Natsuhiro Yamamoto63,K

9、eibun Liu64,65,66,Yuki Wakabayashi67,Shinichi Watanabe68,Hiroshi Yonekura69,Nobuto Nakanishi70,Tetsuya Takahashi11,Osamu Nishida71 and The Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the Japanese Society of Intensive Care Medicine Abst

10、ract Providing standardized,high-quality rehabilitation for critically ill patients is a crucial issue.In 2017,the Japanese Society of Intensive Care Medicine(JSICM)promulgated the“Evidence-Based Expert Consensus for Early Rehabili-tation in the Intensive Care Unit”to advocate for the early initiati

11、on of rehabilitations in Japanese intensive care settings.Building upon this seminal work,JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)methodology.This endeavor resulted in the formulation of Clinical P

12、ractice Guidelines(CPGs),designed to elucidate best practices in early ICU rehabilitation.The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making,ultimately contributing to the enhancement of patient outcomes in critical care

13、 settings.No previous CPGs in the world has focused specically on rehabilitation of critically ill patients,using the GRADE approach.Multidisciplinary collaboration is extremely important in rehabilitation.Thus,the CPGs were developed by 73 members of a Guideline Development Group consisting of a wo

14、rking group,a systematic review*Correspondence:Takeshi UFull list of author information is available at the end of the articlePage 2 of 23 Unokietal.Journal of Intensive Care group,and an academic guideline promotion group,with the Committee for the Clinical Practice Guidelines of Early Mobilization

15、 and Rehabilitation in Intensive Care of the JSICM at its core.Many members contributed to the devel-opment of the guideline,including physicians and healthcare professionals with multiple and diverse specialties,as well as a person who had been patients in ICU.Based on discussions among the group m

16、embers,eight important clinical areas of focus for this CPG were identied.Fourteen important clinical questions(CQs)were then developed for each area.The public was invited to comment twice,and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four b

17、ackground questions.In addition,information for each CQ has been created as a visual clinical ow to ensure that the positioning of each CQ can be easily understood.We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.Keywords Criticall

18、y ill patient,Early rehabilitation,Intensive care,GuidelinesGraphical AbstractIntroductionAlthough advances in intensive care have increased the number of patients who can be saved,after being discharged from the hospital,those patients face a variety of problems that make it dicult for them to retu

19、rn to their daily lives.Rehabilitation for patients who had been critically ill is needed to prevent com-plications and facilitate the return to daily life of these individuals.In 2017,the Japanese Society of Intensive Care Medicine(JSICM)promulgated the“Evidence-Based Expert Consensus for Early Reh

20、abilitation in the Intensive Care Unit”to advocate for the early ini-tiation of rehabilitations in Japanese intensive care set-tings 1.Building upon this seminal work,JSICM has recently conducted a rigorous systematic review(SR)utilizing the Grading of Recommendations,Assess-ment,Development,and Eva

21、luation(GRADE)meth-odology.is endeavor resulted in the formulation Page 3 of 23 Unokietal.Journal of Intensive Care of Clinical Practice Guidelines(CPGs),designed to elucidate best practices in early ICU rehabilitation.e primary objective of this guideline is to augment clinical understanding and th

22、ereby facilitate evidence-based decision-making,ultimately contributing to the enhancement of patient outcomes in critical care set-tings.In developing the CPGs,a Guideline Develop-ment Group(GDG),consisting of the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitati

23、on in Intensive Care of the JSICM,was established.Since multidisciplinary collaboration is extremely important in rehabilitation,the GDG for the CPGs was composed of members from multiple professions(physicians,physical therapists,nurses,occupational therapists,pharmacists,etc.).e physi-cians includ

24、ed not only intensivists but also a variety of specialists,such as rehabilitation physicians,emer-gency medicine physicians,and respiratory physician.In addition,working groups(WGs),which included physical therapists,nurses,physicians,occupational therapists,and a person who had been patients in ICU

25、,were organized as an adjunct to the GDG.To promote the development of CPGs in an appropriate manner,an Academic Guideline Promotion Group was established to provide support from an academic perspective,from a neutral standpoint.To ensure quality and transpar-ency of the work process,the committee c

26、onducted peer review within the committee,open discussions within each team,and solicited public comments.Based on discussions among the group members,eight areas were identied as issues that require attention and were designated as areas of clinical importance.Fourteen clinical questions(CQs)were d

27、eveloped for each area of clinical importance.en,10 GRADE recommendations and four commentaries were provided as answers to the forward questions(FQs)and background questions(BQs),respectively.In addition,we created a clinical ow to allow the positioning of each CQ to be easily under-stood visually.

28、We hope that the CPGs will contribute to eective clinical decision-making for multiple profes-sions involving rehabilitation of critically ill patients.e J-ReCIP 2023 original Japanese version will be published in December 2023 in JSICM ocial journal the Journal of JSICM 2023;Volume 30(Supplement).e

29、 article was translated into English and published in the Journal of Intensive Care,the English-language journals of the society.Namee ocial name of the guideline is“the Japanese Clini-cal Practice Guidelines for Rehabilitation in Critically Ill Patients 2023,”abbreviated to J-ReCIP 2023.Purposee pu

30、rpose of the CPGs is to serve as a reliable guide-line for rehabilitation of critically ill patients and to assist healthcare professionals in making appropriate decisions to improve the prognosis of these patients,as well as the quality of life(QOL)of the patients,their families,and care providers.

31、At the same time,we also aim to identify future research questions.Target populatione target patient population includes patients entering the ICU,and their families and care providers.Patients in the process of recovery after discharge from the ICU,their families,and care providers are also include

32、d.Care providers in this guideline are assumed to be fam-ily members who provided care free-of-charge,rather than nurses,certied care workers,or other personnel.Patients and care providers included in this guideline are assumed to be adults,with the exception of those in some CQs.Perspectives covere

33、d bytheclinical practice guidelinesIn the CPGs,we consider recommendations from the standpoint of the individual patient,family member,and care provider,rather than the general public.Target userse target healthcare professionals are not only those who work with patients and their families in the IC

34、U,but also those who work in general wards and outpatient clinics after patients leave the ICU.Relationship withexisting guidelinesAlthough several CPGs mention rehabilitation of criti-cally ill patients,such as the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2 an

35、d the Japanese Guidelines for the Management of Analgesia,Sedation,and Delirium for Adult ICU Patients 3,no practice guidelines that specically focus on the rehabilitation of critically ill patients are available.A related document,“Evidence based expert consensus for early rehabilitation in the int

36、ensive care unit”(2017)1,by the JSICM,was available,although it is not CPGs.In the CPGs,we conducted SR,used the GRADE approach,and followed standard clinical practice guideline devel-opment methods to describe our recommendations.OrganizationGuideline development groupe GDG consisted of 17 members:

37、one director,who was in charge of the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Page 4 of 23 Unokietal.Journal of Intensive Care Intensive Care of the JSICM,one chairperson,two vice-chairs,12 committee members,and one advisor.e pol-icy was to include

38、a wide variety of professionals involved in rehabilitation,which included intensivists,emergency physicians,rehabilitation physicians,nurses,physical therapists,and other professionals involved in the reha-bilitation of critically ill patients.e GDG selected CQs and PICOs for the CPGs,voted on the r

39、ecommended text,and responded to public comments.e committee members served as group leaders and deputy group leaders of the WGs for each of the key clin-ical areas(hereinafter referred to as“areas”)described below,and with the assistance of the WGs described later,developed the CQs and PICOs,create

40、d the Evi-dence-to-Decision(EtD)table,drafted recommenda-tions,and wrote the text.e advisors were positioned to provide overall advice and were not involved in specic tasks,including voting.In addition,the group leader and deputy group leader of each area,who are members of the committee,did not con

41、duct SR in their area of responsibility.However,they could communicate with the person who conducted the SR via the mailing list as appropriate.In such cases,the Academic Guideline Promotion Group(described below)monitored the content of the communication to ensure that the opinions of the committee

42、 members did not inuence the methods or results of the SR.Working groupse role of WGs was to assist the group leaders of each area,who were the committee members.e WG mem-bers were selected through an open recruitment process and consisted of experts from various professions,who assisted the group l

43、eaders in preparing the CQs,PICOs,EtD tables,and recommendations,as well as involved in SR,if desired.Overall,43 individuals were assigned,with an average of 23 individuals per CQ.Systematic review groupSystematic review members were recruited from among the working groups and also publicly from the

44、 JSICM members.Academic guideline promotion groupis group ensured in the entire process that the devel-opment of the CPGs was carried out in a smooth and appropriate manner.e group drafted,prepared,and distributed various materials,provided advice to the committee members,and conducted peer review.e

45、 group monitored the discussions on the mailing lists of all areas and provided advice as necessary to ensure that the discussions proceeded smoothly.e group also worked to ensure that SR was conducted appropriately by creating videos for those parts of the SR that were di-cult to understand.Importa

46、nt clinical areasFor the important clinical areas,the projected CQs were brainstormed within the GDG and were categorized into eight areas.e following WGs were responsible for each area.WG1.Exercise therapy in ICU(including respiratory physiotherapy).WG2.Neuromuscular electrical stimulation and in-b

47、ed cycle ergometer.WG3.Dysphagia rehabilitation.WG4.Standards for mobilization.WG5.Nutritional therapy.WG6.Rehabilitation for critically ill children.WG7.Rehabilitation after ICU discharge.WG8.Family visitation and family participation in rehabilitation.Scope notcovered bytheclinical practice guidel

48、inesPatients who did not require intensive care in the ICU were not covered.Ways toreect thevalues ofthetarget population(patients,families,andcare providers)To reect the values of the patients and their families,one healthcare provider who had been admitted to an ICU due to a serious condition was

49、added to one of the WGs.Care was taken to ensure that the other WGs could also ask the opinion of that member.Ensuring quality andtransparencye following activities were conducted to ensure quality and transparency.1.Education was provided using videos and manuals to standardize knowledge among all

50、the members.2.Public comments were sought from the JSICM,as well as the Japanese Association of Rehabilitation Medicine,the Japanese Society of Physical erapy,the Japan Academy of Critical Care Nursing,and the Japanese Society of Dysphagia Rehabilitation when drafting the CQs and recommendations.3.P