Son On Yılda Yoğun Bakım Ünitesi İlişkili Kas Güçsüzlüğüne Yönelik Çalışmaların İncelenmesi: Sistematik Derleme

Year 2017, Volume: 4 Issue: 3, 1 - 12, 31.01.2018

Canan Karadaş Sevgisun Kapucu

Abstract

Amaç: Bu çalışma, son on yılda dünyada yoğun bakım ünitesi ile ilişkili kas güçsüzlüğünü önlemede egzersizin etkinliği ve kasta görülen değişimleri belirlemeye yönelik yapılan çalışmaların incelenmesi amacıyla yapılmıştır. Gereç ve Yöntem: Aralık 2015 tarihinde Pubmed ve EBSCO veri tabanları kullanılarak 20052015 yılları arasında toplam 126 makaleye ulaşılmış olup; bunlardan çalışma kriterlerini karşılayan 8 çalışma örnekleme alınmıştır. Çalışmanın anahtar kelimeleri; “YBÜ-KG”, ”Kas güçsüzlüğü”, “Kritik hastalık miyopatisi”, “Kritik hastalık polinöropatisi”, “Yoğun bakım ünitesi” ve “Egzersiz” şeklindendir. Çalışmaya “YBÜ-KG ve egzersiz” konularını içeren randomize kontrollü çalışmalar (RKÇ), prospektif kohort ve prospektif gözlemsel çalışmalar dahil edilmiştir. Bulgular: Çalışmamızda, dört RKÇ, dört prospektif olmak üzere toplam sekiz çalışma incelenmiştir. İncelenen çalışmalarda hareketsizlik ile birlikte kaslarda kas gücü ve miyozin kaybının olduğu, yoğun bakımda kalış süresinin uzaması ile birlikte bu kayıpların arttığı saptanmıştır. Kas gücü azalmasına bağlı oluşan sorunun, iyileşme süresinin 12 aydan daha uzun sürdüğü görülmüştür. İncelenen çalışmalar; uygulanan egzersizin türü, süresi, yoğunluğu ve hasta popülasyonun özelliğine bakılmaksızın; hastalara yaptırılan egzersizin olumlu etkisi olduğu belirtilmiştir. Sonuç: Kas güçsüzlüğüne bağlı yapılan son on yıldaki araştırmaların yakın zamanlarda artış gösterdiği, araştırma biçimlerinin homojen olmadığı, kullanılan ölçme araçlarının farklılık gösterdiği belirlenmiştir. Yoğun bakım ünitesi ilişkili kas güçsüzlüğünde altta yatan faktörlerin belirlenmesi ve yönetiminde egzersizin etkisine yönelik daha fazla kanıt temelli çalışma yapılmasına ihtiyaç duyulduğu belirlenmiştir.

Keywords

Egzersiz, kas güçsüzlüğü, kritik hastalık, polinöropati, yoğun bakım ünitesi

Examination of Studies on Intensive Care Unit-Acquired Muscle Weakness in Last Decade: A Systematic Review

Abstract

Aim: This study aims to investigate the studies conducted in last 10 years on prevention of intensive care unit acquired weakness (ICU-AW) by alteration in muscles and the effect of exercises. Material and Methods: By reaching total of 126 studies published between 2005-2015 in December 2015 via using Pubmed and EBSCO Databases, eight of these studies that met the study criteria were included in the sample. “ICU-AW”, “Muscle Weakness”, “Critical illness myopathy”, “Critical illness polyneuropathy”, “Intensive care unit”, and “Exercise” were the keywords for the study. Randomized controlled trials (RCTs), prospective cohorts and prospective observational studies that contains “ICU-AW and Exercise” issues were included in the study. Results: Total of eight studies, including four RCTs and four prospective studies, were investigated in our study. Reviewed studies showed that loss of muscle strength and myosin occurred with immobility, these losses increased with the extension of ICU stay. It was observed that recovery period of the problem caused by muscle weakness took longer than 12 months. Regardless of type, duration, intensity of exercise, and the patients’ characteristics; studies stated that exercise had positive effects. Conclusion: It has been determined that studies on ICU-AW in last ten years have recently shown an increase, research methodologies are not homogeneous, and the measuring instruments varied. More evidence-based study are needed to determine and manage the underlying factors of ICU-AW.

Keywords

Exercise, muscle weakness, critical illness, polyneuropathy, intensive care unit.

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