JAMA. 2018 Jul 24;320(4):368-378.

BackgroundICU 50%

ICU-AW ICU-AW

ICU-AW

BackgroundICU

ICU-AW ICU

Cycle ergometer

2 ICU

Schweickert WD, et al. Lancet 2009;373:1874-82.

2009 Schweickert

Background

2009 Schweickert

2009 12 21 http://www.jseptic.com/journal/jreview_014.ppt.

http://www.jseptic.com/journal/jreview_014.ppt.%E3%82%88

• 18• 72 24

• 2 Barthel Index 70

Methods

Barthel Index

ADL

•• CPA• 6 50

••• trial

Methods

– 1 1– 10

→ → →→ → →

– ADL

– 1 1–

Methods

– ―–– 1 3 8.3mmoL/L 149.4mg/dL

CVII

Methods

24– Barthel Index score– ADL–– ICU-AW–

Methods

Results

JAMA. 2018 Jul 24;320(4):368-378.

Methods

20 medical-surgical ICU2014 7 2016 6

(6 2016 11 24 )1)182) ICU 723)ICU 484)ICU 15

Barthel index > 55 ( )

1)2) ICU

3) ICD4) 725)6)7)8) DVT 489)10)11)12)

Methods

ICU VS

4 6

Methods

ICU

SchweickertROM

1550

Methods

MOTOmed letto2

https://www.mobilefrance.fr/galeries-photos-motomed-letto2-g5.html

http://www.medicalexpo.com/prod/cefarcompex/product-67974-434989.html

Rehab400

Methods

Primary Outcome-ICU MRC (0-60)

Secondary Outcome- ICU

L12-3MHz linear array transducer

Methods

Medical Research Council(MRC) scale

::

0

1

2

3

4

5

600

Kleyweg RP, et al. Muscle Nerve. ;14(11):1103-9.

Stevens RD, et al. Crit Care Med 2009; 37[Suppl.]:S299 –S308

1 2 3or4 5 .12

3 24 2 MRC score 48MRC score 4

45

ICU-AW

3

1

2009 Seymour

Thorax. 2009 May;64(5):418-23.

Clin Nutr. 2017 Dec;36(6):1710-1715.

Secondary Outcome-ICU ICU mobility scale-ICU CAM-ICU- Katz Index ICU ICU

Barthel Index ADL

- 28ICU ICU

28

Methods

Secondary Outcome-QOL SF-36

ICU

-

Methods

CAM-ICU

MOS 36-Item Short-Form Health Survey

Sample Size

SchweickertMRC 4

1 5% 90%150

Methods

CIDP IVIG

J Neurol Neurosurg Psychiatry. 2010 Nov;81(11):1194-9.

Statistical Analysis

ICU 0

ICU MICE (Mul4variate Imputa4on by Chained Equa4ons)

Primary OutcomeMann-Whitney test

Methods

Statistical Analysis

95%CI

6

R

Methods

Results498 314

159 155

Results

2

ICU MRC 2

Primary OutcomeResults

Secondary Outcome

2

Results

Secondary Outcome

2

Results

( 7 4.4% 9 (5.8%))

Per protocol

Results

Per protocol

Results

Discussionprimary outcome secondary outcome

cycling exercise

Discussion

ICU 30cycling

exercise ICU7

DiscussionICU

ICU

MRC

MRC

Discussion

ConclusionICU

ICU

MRC

Limitation

ICU-AW MRC

BMJ Open. 2018 May 5;8(5):e019998.

ICU

ICU

MRC Outcome RCT

BMJ Open. 2018 May 5;8(5):e019998.

ICU

52[25 - 58]VS 48[0 - 58] (p=0.38)

50.4 7.5 VS 45.2 13.2 (p=0.10)

51.9 10.5 VS 47.3 13.6 (p=0.24)

Early rehabilitation VS Control

ICU-AW Outcome RCT

BMJ Open. 2018 May 5;8(5):e019998.

ICU

7/25(28%) VS 10/20(50%) (p=0.13)

15/49(31%) VS 27/55(49%) (p=0.09)

Early rehabilitation VS Control

MRC

Crit Care Med. 2015 Apr;43(4):897-905.

2015

4

2009 Seymour

Thorax. 2009 May;64(5):418-23.

COPD

JAMA. 2013 Oct 16;310(15):1591-600.

-18 48 ICU 7

--

-ICU 1 3 7 10

DNA-

P = 0.03

P = 0.31Day1 to day7 change Decrease rate [95% CI]

RFCSA -10.3% [-6.1 to -14.5] fiberCSA -17.5%

[-5.8 to -29.3] change in protein:DNA ratio -29.5% [-13.4 to -45.6]

ICU

0.035%/hour[0.023-0.047]

0.039%/hour[0.029-0.048]

0.076%/hour[0.032-0.120]

0.065%/ hour[0.049-0.080]

P=0.03

P = 0.025

P = 0.019

Am J Respir Crit Care Med. 2017 Jan 1;195(1):136-138.

Day1 to day7 change Decrease rate [95% CI] Thickness -4.6%

[-14.19 to 4.95] fiberCSA -16.4%

[-32.0 to -0.74] change in protein:DNA ratio -30.9% [-51.2 to -10.6]

Crit Care Med. 2018 Sep;46(9):1436-1443.

ICU 72

Methods

•••••• CPA• ICU 7

Methods

–– 1 2 (7/7day)– 30 (MOTOmed Letto2)

–– (5/7day)

Methods

Primary Outcome-- ubiquitin-proteasome pathway (UPP) autophagy- Akt-mTOR pathway

Secondary Outcome--MRC

Methods

Results

Variables)Control)group) )

n=10)

Intervention)

group)n=9)p"value#

Indirect)calorimetry) 70%)(7)) 56%)(5)) 0.65)

Measured)REE)by)indirect)calorimetry)

(kcal/24h))1823±437)(n=7)) 1960±724)(n=5)) 0.69)

Theoretical)REE)(kcal/24h)*) 1549±171)(n=3)) 1535±343)(n=4)) 0.91)

Prescribed)REE)(kcal/24h)†) 1652±376) 1692±621) 0.94)

Administered)nutritional)support)

(kcal/24h))1239±357) 1414±816) 0.54)

Difference)administeredPprescribed) )

nutritional)support)(%))P24±21) P20±27) 0.73)

) ) Day)1)(%)) P47±31) P28±32) 0.58)

) ) Day)2)(%)) P10±33) P18±23) 0.60)

) ) Day)3)(%)) P16±28) P28±33) 0.38)

) ) Day)4)(%)) P27±27) P11±33) 0.30)

) ) Day)5)(%)) P23±34) P13±28) 0.53)

) ) Day)6)(%)) P25±35) P3±33) 0.20)

) ) Day)7)(%)) P22±32) P7±32) 0.33)

Administered)proteins)(g/kg/day)) 0.91±0.30) 1.05±0.57) 0.52)

Nitrogen)balance~) P4.53±4.74)(n=8)) P2.55±2.63)(n=8)) 0.46)

Insulin)dose)at)Biopsy)1)(Ul/h)) 1.45±1.96) 0.72±0.76) 0.31)

Insulin)dose)at)Biopsy)2)(Ul/h)) 1.56±1.99) 1.15±1.22) 0.66)

Glycaemia)at)Biopsy)1)(mmol/l)) 7.21±1.58) 8.17±1.59) 0.21)

Glycaemia)at)Biopsy)2)(mmol/l)) 7.88±1.70) 7.88±2.48) 0.99)

Nutritional)route)

) ) ) Only)parenteral) P) P) )

) ) ) Parenteral)and)oral) P) 11%)(1)) )

Results

Autophagy

lysosomal-associated membrane protein (LAMP) 2. LAMP2/p62 colocalization

Autophagy

MRC

Results

Conclusion

Autophagy

Lancet Respir Med. 2013 Oct;1(8):621-9.

ICU 48

autophagy

cycle

8 1 autophagy

ICU-AW

2018 JAMA Fossat