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Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, Martin CM, Mele TS, Sharpe M, Shoemaker JK, Fraser DD. Early mobilization in the critical care unit: A review of adult and pediatric literature. J Crit Care 2015; 30:664-72. [PMID: 25987293 DOI: 10.1016/j.jcrc.2015.03.032] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/19/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022]
Abstract
Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
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Affiliation(s)
- Saoirse Cameron
- Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study
| | - Ian Ball
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada
| | - Gediminas Cepinskas
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medical Biophysics, Western University, London, ON, Canada
| | - Karen Choong
- Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Timothy J Doherty
- Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Christopher G Ellis
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada; Medical Biophysics, Western University, London, ON, Canada
| | - Claudio M Martin
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada
| | - Tina S Mele
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Surgery, Western University, London, ON, Canada
| | - Michael Sharpe
- Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Anesthesia and Perioperative Medicine, Western University, London, ON, Canada
| | - J Kevin Shoemaker
- Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Kinesiology, Western University, London, ON, Canada
| | - Douglas D Fraser
- Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Pediatrics, Western University, London, ON, Canada.
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Günes ÜY, Efteli E. Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study. Ostomy Wound Manage 2015; 61:58-62. [PMID: 25853378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Multiple pressure ulcer (PU) risk assessment instruments have been developed and tested, but there is no general consensus on which instrument to use for specific patient populations and care settings. The purpose of this study was to determine the reliability and predictive validity of the Turkish version of the Risk Assessment Pressure Sore (RAPS) instrument, which includes 12 variables--5 from the modified Norton Scale, 3 from the Braden Scale, and 3 from other research results--for use in intensive care unit (ICU) patients. The English version of the RAPS instrument was translated into Turkish and tested for internal consistency and predictive validity (sensitivity, specificity, positive predictive value, and negative predictive value) using a convenience sample of 122 patients consecutively admitted to an ICU unit in Turkey. The patients were assessed within 24 hours of admission, and after that, once a week until the development of a PU or discharge from the unit. The incidence of PUs in this population was 23%. The majority of ulcers that developed were Stage I. Internal consistency of the RAPS tool was adequate (Cronbach's α = 0.81). The best balance between sensitivity and specificity for ICU patients was reached at a cut-off point of ≤ 27 (ie, sensitivity = 74.2%, specificity = 31.8%, positive predictive value = 38.7%, and negative predictive value 91.3%). This is lower than the cut-off point reported in other studies of the RAPS scale. In this population of ICU patients, the RAPS scale was found to have acceptable reliability and poor validity. Additional studies to evaluate the predictive validity and reliability of the RAPS scale in other patient populations and care settings are needed.
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Affiliation(s)
| | - Elçin Efteli
- Ege University Faculty of Nursing, İzmir, Bornova, Turkey
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Connolly B, Thompson A, Douiri A, Moxham J, Hart N. Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: A pilot feasibility trial. J Crit Care 2015; 30:589-98. [PMID: 25703957 PMCID: PMC4416081 DOI: 10.1016/j.jcrc.2015.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/05/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
Purpose The aim of this study was to investigate feasibility of exercise-based rehabilitation delivered after hospital discharge in patients with intensive care unit–acquired weakness (ICU-AW). Materials and methods Twenty adult patients, mechanically ventilated for more than 48 hours, with ICU-AW diagnosis at ICU discharge were included in a pilot feasibility randomized controlled trial receiving a 16-session exercise-based rehabilitation program. Twenty-one patients without ICU-AW participated in a nested observational cohort study. Feasibility, clinical, and patient-centered outcomes were measured at hospital discharge and at 3 months. Results Intervention feasibility was demonstrated by high adherence and patient acceptability, and absence of adverse events, but this must be offset by the low proportion of enrolment for those screened. The study was underpowered to detect effectiveness of the intervention. The use of manual muscle testing for the diagnosis of ICU-AW lacked robustness as an eligibility criterion and lacked discrimination for identifying rehabilitation requirements. Process evaluation of the trial identified methodological factors, categorized by “population,” “intervention,” “control group,” and “outcome.” Conclusions Important data detailing the design, conduct, and implementation of a multicenter randomized controlled trial of exercise-based rehabilitation for survivors of critical illness after hospital discharge have been reported. Registration Clinical Trials Identifier NCT00976807
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Affiliation(s)
- Bronwen Connolly
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK; Guy's & St Thomas' NHS Foundation Trust and King's College London, National Institutes of Health Research Biomedical Research Centre, London, UK; Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
| | - April Thompson
- Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - John Moxham
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Nicholas Hart
- Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK; Guy's & St Thomas' NHS Foundation Trust and King's College London, National Institutes of Health Research Biomedical Research Centre, London, UK; Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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Ullman A, Aitken L. The use of diaries to promote recovery after critical illness. Qld Nurse 2014; 33:26. [PMID: 25438470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Admission to intensive care exposes patients and family members to extreme physical and psychological stress. This stress may cause anxiety, depression and post-traumatic stress disorder (PTSD), which impairs their recovery. Nurses are actively seeking solutions and tools to assist patients and family members to recover after admission to intensive care.
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Mccormick S, Patel C. Recovery after critical illness; when, how and who should be involved? Clin Med (Lond) 2014; 14:558-9. [PMID: 25301927 PMCID: PMC4951975 DOI: 10.7861/clinmedicine.14-5-558a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sarah Mccormick
- Department of Anaesthesia, Dudley NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
| | - Chandresh Patel
- Department of Anaesthesia, Dudley NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
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Abstract
BACKGROUND A high amount of recently published articles and reviews have already focused on early mobilisation in intensive care medicine. However, in the clinical setting the problem of its practicability remains as each professional group in the mobility team has its own expectations concerning the interventions made by physiotherapy. Even though there are as yet no standard operation procedures (SOP), there do exist distinctive mobilisation concepts that are well implemented in certain intensive care units (http://www.fruehmobilisierung.de/Fruehmobilisierung/Algorithmen.html). AIM Due to these facts and the urgent need for SOPs this article presents the physiotherapeutic concept for the treatment of patients in the intensive care unit which has been developed by the author: First the patients' respiratory and motor functions have to be established in order to classify the patients and allocate them to their appropriate group (one out of three) according to their capacities; additionally, the patients are analysed by checking their so-called "surrounding conditions". Following these criteria a therapy regime is developed and patients are treated accordingly. By constant monitoring and re-evaluation of the treatment in accordance with the functions of the patient a dynamic system evolves. "Keep it simple" is one of the key features of that physiotherapeutic concept. Thus, a manual for the classification and the physiotherapeutic treatment of an intensive care patient was developed. METHODS In this article it is demonstrated how this concept can be implemented in the daily routine of an intensive care unit. Physiotherapy in intensive care medicine has proven to play an important role in the patients' early rehabilitation if the therapeutic interventions are well adjusted to the needs of the patients. A team of nursing staff, physiotherapists and medical doctors from the core facility for medical intensive care and emergency medicine at the medical university of Innsbruck developed the "Mobilisation Concept for the Multidisciplinary Treatment of the Intensive Care Patient" following the principles of the physiotherapeutic concept mentioned above and published it online on the homepage of the German network for early mobilisation (http://www.fruehmobilisierung.de/Fruehmobilisierung/Algorithmen.html) in spring 2012. The biggest challenge was to find one common language for all professional groups to define the aims of mobilisation. RESULTS The success of the implementation becomes apparent in a well structured and coordinated procedure of early mobilisation, as all partners of the rehabilitation team apply adequate treatments. As a result the patients receive the appropriate treatment at the appropriate time which greatly supports their convalescence.
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Affiliation(s)
- S Nessizius
- Gemeinsame Einrichtung für Intensiv- und Notfallmedizin des Departments Innere Medizin, Universitätskliniken Innsbruck, Anichstraße 34, 6020, Innsbruck, Deutschland,
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Abstract
Many ICU patients struggle to recovery following critical illness and may be left with physical, cognitive and psychological problems, which have a negative impact on their quality of life. Gross muscle mass loss and weakness can take some months to recover after the patients' Intensive Care Unit (ICU) discharge, in addition critical illness polyneuropathies can further complicate physical recovery. Psychological problems such as anxiety, depression and post traumatic stress disorder (PTSD) are common and have an negative impact on the patients' ability to engage in rehabilitation after ICU discharge. Finally cognitive deficit affecting memory can be a significant problem. The first step in helping patients to recover from such a devastating illness is to recognise those who have the greatest need and target interventions. Research now suggests that there are interventions that can accelerate physical recovery and reduce the incidence of psychological problems such as anxiety, depression and PTSD. Cognitive rehabilitation, however, is still in its infancy. This review will look at the research into patients' recovery and what can be done to improve this where needed.
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Affiliation(s)
- Christina Jones
- Critical Care Rehabilitation, Whiston Hospital, Prescot L35 5DR, UK; Institute of Ageing & Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK.
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Choong K, Foster G, Fraser DD, Hutchison JS, Joffe AR, Jouvet PA, Menon K, Pullenayegum E, Ward RE. Acute rehabilitation practices in critically ill children: a multicenter study. Pediatr Crit Care Med 2014. [PMID: 24777303 DOI: 10.1097/01.pcc.0000448748.47635.b2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate acute rehabilitation practices in pediatric critical care units across Canada. DESIGN Retrospective cohort study. SETTING Six Canadian, tertiary care pediatric critical care units. PATIENTS/SUBJECTS Six hundred children aged under 17 years admitted to pediatric critical care unit during a winter and summer month of 2011 with a greater than 24-hour length of stay. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome of interest was the nature and timing of pediatric critical care unit rehabilitation practices.Rehabilitation was classified according to mobility and nonmobility interventions. Predictors of mobilization and the time to mobilization were evaluated through regression and time-dependent survival analyses, respectively. The most common form of rehabilitation provided in pediatric critical care unit was physical therapy (45.5% patients) followed by occupational therapy (4.5%) and speech and language therapy (1.5%). Interventions were primarily nonmobility in nature (69.7% of sessions), most frequently in the form of chest physiotherapy (42.7% of sessions). The median time to mobilization was 2 days (interquartile range, 1-6) as compared with 1 day for nonmobility interventions (interquartile range, 1-3). Only 57 patients (9.5%) received early mobilization. Regression analyses revealed that increasing age, admission during winter, neuromuscular blockade, and sedative infusions were associated with an increased likelihood of receiving mobility therapy. Increasing age was a predictor of early mobilization, while neuromuscular blockade was associated with delayed mobilization. No significant differences in adverse events were found between nonmobility and mobility interventions. CONCLUSIONS Only half of the children receive rehabilitation while in the pediatric critical care unit, and when it occurs, therapy is primarily focused on respiratory function. Mobilization appears to be reserved for at-risk children who were muscle relaxed and sedated; however, its implementation in these patients is delayed. Future pediatric-specific research is essential to identify patients at risk and to understand treatment priorities and rehabilitation strategies to improve functional recovery in critically ill children.
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Affiliation(s)
- Karen Choong
- 1Department of Pediatrics, Critical Care, Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 2Department of Clinical Epidemiology and Biostatistics, McMaster University & Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada. 3Department of Pediatrics and Critical Care, Children's Hospital, London Health Sciences Centre, London, ON, Canada. 4Department of Pediatrics and Critical Care, The Hospital for Sick Children, Toronto, ON, Canada. 5Department of Pediatrics and Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. 6Department of Pediatrics, CHU Ste-Justine, Montreal, QC, Canada. 7Department of Pediatrics, Epidemiology and Biostatistics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 8Child Health Evaluative Sciences, Hospital for Sick Children & Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 9Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Connolly B, Douiri A, Steier J, Moxham J, Denehy L, Hart N. A UK survey of rehabilitation following critical illness: implementation of NICE Clinical Guidance 83 (CG83) following hospital discharge. BMJ Open 2014; 4:e004963. [PMID: 24833691 PMCID: PMC4025447 DOI: 10.1136/bmjopen-2014-004963] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine the implementation of National Institute for Health and Care Excellence guidance (NICE CG83) for posthospital discharge critical illness follow-up and rehabilitation programmes. DESIGN Closed-question postal survey. SETTING Adult intensive care units (ICUs) across the UK, identified from national databases of organisations. Specialist-only and private ICUs were not included. PARTICIPANTS Senior respiratory critical care physiotherapy clinicians. RESULTS A representative sample of 182 surveys was returned from the 240 distributed (75.8% (95% CI 70.4 to 81.2)). Only 48 organisations (27.3% (95% CI 20.7 to 33.9)) offered a follow-up service 2-3 months following hospital discharge, the majority (n=39, 84.8%) in clinic format. 12 organisations reported posthospital discharge rehabilitation programmes (6.8% (95% CI 3.1 to 10.5)), albeit only 10 of these operated on a regular basis. Lack of funding was reported as the most frequent (n=149/164, 90%) and main barrier (n=99/156, 63.5%) to providing services. Insufficient resources (n=71/164, 43.3%) and lack of priority by the clinical management team (n=66/164, 40.2%) were also highly cited barriers to service delivery. CONCLUSIONS NICE CG83 has been successful in profiling the importance of rehabilitation for survivors of critical illness. However, 4 years following publication of CG83 there has been limited development of this clinical service across the UK. Strategies to support delivery of such quality improvement programmes are urgently required to enhance patient care.
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Affiliation(s)
- Bronwen Connolly
- Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre, London, UK
- Lane Fox Clinical Respiratory Physiology Research Unit, St Thomas’ Hospital, Guy's & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - A Douiri
- Department of Public Health Sciences, King's College London, London, UK
| | - J Steier
- Lane Fox Clinical Respiratory Physiology Research Unit, St Thomas’ Hospital, Guy's & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - J Moxham
- Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - L Denehy
- Department of Physiotherapy, School of Health Sciences, University of Melbourne, Parkville, Melbourne, Australia
| | - N Hart
- Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre, London, UK
- Lane Fox Clinical Respiratory Physiology Research Unit, St Thomas’ Hospital, Guy's & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, UK
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Affiliation(s)
- John P Kress
- From the Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago
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Affiliation(s)
- Michael P Casaer
- From the Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
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Chemonges S, Shekar K, Tung JP, Dunster KR, Diab S, Platts D, Watts RP, Gregory SD, Foley S, Simonova G, McDonald C, Hayes R, Bellpart J, Timms D, Chew M, Fung YL, Toon M, Maybauer MO, Fraser JF. Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. Biomed Res Int 2014; 2014:468309. [PMID: 24783206 PMCID: PMC3982457 DOI: 10.1155/2014/468309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/21/2014] [Accepted: 02/10/2014] [Indexed: 12/18/2022]
Abstract
Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.
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Affiliation(s)
- Saul Chemonges
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Medical Engineering Research Facility (MERF), Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Kiran Shekar
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Bond University, Gold Coast, QLD 4226, Australia
| | - John-Paul Tung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD 4059, Australia
| | - Kimble R Dunster
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Sara Diab
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - David Platts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Ryan P Watts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Department of Emergency Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Shaun D Gregory
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Samuel Foley
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Gabriela Simonova
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Charles McDonald
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Rylan Hayes
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Judith Bellpart
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Daniel Timms
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Michelle Chew
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Yoke L Fung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Michael Toon
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Marc O Maybauer
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - John F Fraser
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
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Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG, Graves AJ, Shintani A, Murphy E, Work B, Pun BT, Boehm L, Gill TM, Dittus RS, Jackson JC. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med 2014; 40:370-9. [PMID: 24257969 PMCID: PMC3943568 DOI: 10.1007/s00134-013-3136-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/07/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE Cognitive impairment after critical illness is common and debilitating. We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness. METHODS We randomized 87 medical and surgical ICU patients with respiratory failure and/or shock in a 1:1:2 manner to three groups: usual care, early once-daily physical therapy, or early once-daily physical therapy plus a novel, progressive, twice-daily cognitive therapy protocol. Cognitive therapy included orientation, memory, attention, and problem-solving exercises, and other activities. We assessed feasibility outcomes of the early cognitive plus physical therapy intervention. At 3 months, we also assessed cognitive, functional, and health-related quality of life outcomes. Data are presented as median (interquartile range) or frequency (%). RESULTS Early cognitive therapy was a delivered to 41/43 (95%) of cognitive plus physical therapy patients on 100% (92-100%) of study days beginning 1.0 (1.0-1.0) day following enrollment. Physical therapy was received by 17/22 (77%) of usual care patients, by 21/22 (95%) of physical therapy only patients, and 42/43 (98%) of cognitive plus physical therapy patients on 17% (10-26%), 67% (46-87%), and 75% (59-88%) of study days, respectively. Cognitive, functional, and health-related quality of life outcomes did not differ between groups at 3-month follow-up. CONCLUSIONS This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy. Future work to determine optimal patient selection, intensity of treatment, and benefits of cognitive therapy in the critically ill is needed.
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Affiliation(s)
- N E Brummel
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 350, Nashville, TN, 37203-1425, USA,
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Manning JC, Hemingway P, Redsell SA. Protocol for a longitudinal qualitative study: survivors of childhood critical illness exploring long-term psychosocial well-being and needs--The SCETCH Project. BMJ Open 2014; 4:e004230. [PMID: 24435896 PMCID: PMC3902363 DOI: 10.1136/bmjopen-2013-004230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Life-threatening critical illness affects over a quarter of a million children and adolescents (0-18 years old) annually in the USA and the UK. Death from critical illness is rare; however, survivors and their families can be exposed to a complex array of negative physical, psychological and social problems. Currently, within the literature, there is a distinct paucity of child and adolescent survivor self-reports, thus limiting our understanding of how survivors perceive this adversity and subsequently cope and grow in the long-term following their critical illness. This study aims to explore and understand psychosocial well-being and needs of critical illness survivors, 6-20 months post paediatric intensive care admission. METHODS AND ANALYSIS A longitudinal, qualitative approach will provide a platform for a holistic and contextualised exploration of outcomes and mechanisms at an individual level. Up to 80 participants, including 20 childhood critical illness survivors and 60 associated family members or health professionals/teachers, will be recruited. Three interviews, 7-9 weeks apart, will be conducted with critical illness survivors, allowing for the exploration of psychosocial well-being over time. A single interview will be conducted with the other participants enabling the exploration of contextual information and how psychosocial well-being may inter-relate between critical illness survivors and themselves. A 'tool box' of qualitative methods (semi-structured interviews, draw and tell, photo-elicitation, graphic-elicitation) will be used to collect data. Narrative analysis and pattern matching will be used to identify emergent themes across participants. ETHICS AND DISSEMINATION This study will provide an insight and understanding of participants' experiences and perspectives of surviving critical illness in the long term with specific relation to their psychosocial well-being. Multiple methods will be used to ensure that the findings are effectively disseminated to service users, clinicians, policy and academic audiences. The study has full ethical approval from the East Midlands Research Ethics Committee and has received National Health Service (NHS) governance clearance.
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Affiliation(s)
- Joseph C Manning
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Paediatric Intensive Care Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pippa Hemingway
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah A Redsell
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
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Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, Gough K, Hoorn SV, Morris ME, Berney S. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care 2013; 17:R156. [PMID: 23883525 PMCID: PMC4056792 DOI: 10.1186/cc12835] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/09/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors. METHODS We conducted a single-center, assessor-blinded, randomized controlled trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult. The intervention group received intensive exercises in the ICU and the ward and as outpatients. Participants were assessed at recruitment, ICU admission, hospital discharge and at 3-, 6- and 12-month follow-up. Physical function was evaluated using the Six-Minute Walk Test (6MWT) (primary outcome), the Timed Up and Go Test and the Physical Function in ICU Test. Patient-reported outcomes were measured using the Short Form 36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life (AQoL) Instrument. Data were analyzed using mixed models. RESULTS The a priori enrollment goal was not reached. There were no between-group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) (Acute Physiology and Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24 days). No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge. However, exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group. CONCLUSIONS Further research examining the trajectory of improvement with rehabilitation is warranted in this population. TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.
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Affiliation(s)
- Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | | | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | | | | | - Graeme Hawthorne
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Karla Gough
- Cancer Nursing Research Centre, Peter MacCallum Cancer Institute, Melbourne, Australia
| | - Steven Vander Hoorn
- Department of Mathematics and Statistics, The University of Melbourne, Melbourne, Australia
| | - Meg E Morris
- School of Allied Health, Latrobe University Melbourne, Melbourne, Australia
| | - Sue Berney
- Physiotherapy Department, Austin Health, Melbourne, Australia
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Bell L. Early passive mobility. Am J Crit Care 2013; 22:350. [PMID: 23817824 DOI: 10.4037/ajcc2013177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Blum JM, Morris PE, Martin GS, Gong MN, Bhagwanjee S, Cairns CB, Cobb JP. United States Critical Illness and Injury Trials Group. Chest 2013; 143:808-813. [PMID: 23460158 PMCID: PMC3590888 DOI: 10.1378/chest.12-2287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 09/18/2012] [Indexed: 11/01/2022] Open
Abstract
The United States Critical Illness and Injury Trials (USCIIT) Group is an inclusive, grassroots "network of networks" with the dual missions of fostering investigator-initiated hypothesis testing and developing recommendations for strategic plans at a national level. The USCIIT Group's transformational approach enlists multidisciplinary investigative teams across institutions, critical illness and injury professional organizations, federal agencies that fund clinical and translational research, and industry partners. The USCIIT Group is endorsed by all major critical illness and injury professional organizations spanning the specialties of anesthesiology, emergency medicine, internal medicine, neurology, nursing, pediatrics, pharmacy and nutrition, surgery and trauma, and respiratory and physical therapy. Recent successes provide the opportunity to significantly increase the dialogue necessary to advance clinical and translational research on behalf of our community. More than 200 investigators are now involved across > 30 academic and community hospitals. Collectively, USCIIT Group investigators have enrolled > 10,000 patients from academic and community hospitals in studies during the last 3 years. To keep our readership "ahead of the curve," this article provides a vision for critical illness and injury research based on (1) programmatic organization of large-scale, multicentered collaborative studies and (2) annual strategic planning at a national scale across disciplines and stakeholders.
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Affiliation(s)
- James M Blum
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Peter E Morris
- Department of Medicine, Wake Forest University, Winston-Salem, NC
| | - Greg S Martin
- Department of Medicine, Emory University, Atlanta, GA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University, New York, NY
| | - Satish Bhagwanjee
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Charles B Cairns
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - J Perren Cobb
- Departments of Anesthesiology and Surgery, Harvard Medical School, Boston, MA.
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Tipping CJ, Young PJ, Romero L, Saxena MK, Dulhunty J, Hodgson CL. A systematic review of measurements of physical function in critically ill adults. CRIT CARE RESUSC 2012; 14:302-311. [PMID: 23230880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients who recover from critical illness may be left with significant limitations to their physical function that can have important consequences for their quality of life. Measures of physical function may be useful end points to consider in studies conducted in critically ill patients and are particularly attractive in studies investigating early mobilisation and rehabilitation. OBJECTIVE To describe measurements of physical function used in studies investigating early mobilisation and rehabilitation in critically ill adults. METHODS A systematic search of Ovid MEDLINE, Embase, CINAHL, Cochrane Library and PEDro was undertaken to identify studies investigating early mobilisation and rehabilitation in critically ill adults. Two researchers independently extracted data from identified studies that described measurements of physical function and that evaluated the available evidence for the measurement properties and risk of bias associated with the identified end points. RESULTS We identified 11 studies of early mobilisation and rehabilitation in critically ill patients, involving 19 distinct measures of physical function. The ability to perform activities such as sitting and standing and the maximum distance ambulated were the most commonly used end points. Only one end point in the included studies, the Functional Status Score for the ICU (FSS-ICU), was designed for use in the ICU setting. Of the end points used, only the Short Form 36 (SF-36), the Medical Research Council (MRC) scale score and handheld dynamometers have proven interrater reliability and population validity in the ICU setting. CONCLUSION A wide range of end points have been used to evaluate physical function in critically ill patients. However, further studies are needed to establish the measurement properties of the most commonly used end points in order to recommend their use in clinical trials.
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121
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Poulsen JB. Impaired physical function, loss of muscle mass and assessment of biomechanical properties in critical ill patients. Dan Med J 2012; 59:B4544. [PMID: 23171753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intensive care unit (ICU) admission is associated with muscle weakness and ICU survivors report sustained limitation of physical capacity for years after discharge. Limited information is available on the underlying biomechanical properties responsible for this muscle function impairment. A plausible contributor to the accentuated catabolic drive in ICU patients is a synergistic response to inflammation and inactivity leading to loss of muscle mass. As these entities are predominantly present in the early phase of ICU stay, interventions employed during this time frame may exhibit the greatest potential to counteract loss of muscle mass. Despite the obvious clinical significance of muscle atrophy for the functional impairment observed in ICU survivors, no preventive therapies have been identified as yet. The overall aim of the present dissertation is to characterize aspects of physical function and biomechanical properties in ICU patients and to provide new insights into ICU-induced muscle wasting and the underlying biomechanical mechanisms responsible for the residual impairment of physical function in ICU survivors.
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Affiliation(s)
- Jesper Brøndum Poulsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Abstract
Since 2000, there has been an ongoing debate regarding tightness of glycemic control in critically ill patients. An increased risk of hypoglycemia is observed in patients treated with an intensive insulin protocol targeting "normoglycemia," probably accounting for a reduction of the overall benefit. Hypoglycemia is associated with neurological side effects and is found to be an independent predictor of mortality in most trials; however, long-term sequelae are rare if glucose is administered early. We describe a case of prolonged, extreme hypoglycemia in a critically ill patient treated according to an intensive insulin protocol who recovered without any neurological deficit at discharge.
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Affiliation(s)
- Veerle M Piot
- Department of Anesthesiology and Intensive Care, Catharina Ziekenhuis, Eindhoven, The Netherlands.
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Abstract
Patients undergoing critical illness and mechanical ventilation are at risk of developing neuromuscular and neurocognitive impairments that can impact physical function and quality of life. Mobilizing patients early in the course of critical illness may improve outcomes. Recent literature on early mobilization is reviewed, suggestions for implementation are discussed, and areas for future research are identified.
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Affiliation(s)
- Amy J Pawlik
- Therapy Services, University of Chicago Medical Center, MC 1081, W109, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
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124
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Connolly B, Denehy L, Brett S, Elliott D, Hart N. Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review. Crit Care 2012; 16:226. [PMID: 22713336 PMCID: PMC3580599 DOI: 10.1186/cc11219] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although clinical trials have shown benefit from early rehabilitation within the ICU, rehabilitation of patients following critical illness is increasingly acknowledged as an area of clinical importance. However, despite recommendations from published guidelines for rehabilitation to continue following hospital discharge, there is limited evidence to underpin practice during this intermediate stage of recovery. Those patients with ICU-acquired weakness on discharge from the ICU are most likely to benefit from ongoing rehabilitation. Despite this, screening based on strength alone may fail to account for the associated level of physical functioning, which may not correlate with muscle strength, nor address non-physical complications of critical illness. The aim of this review was to consider which patients are likely to require rehabilitation following critical illness and to perform an integrative review of the available evidence of content and nature of exercise rehabilitation programmes for survivors of critical illness following hospital discharge. Literature databases and clinical trials registries were searched using appropriate terms and groups of terms. Inclusion criteria specified the reporting of rehabilitation programmes for patients following critical illness post-hospital discharge. Ten items, including data from published studies and protocols from trial registries, were included. Because of the variability in study methodology and inadequate level of detail of reported exercise prescription, at present there can be no clear recommendations for clinical practice from this review. As this area of clinical practice remains in its relative infancy, further evidence is required both to identify which patients are most likely to benefit and to determine the optimum content and format of exercise rehabilitation programmes for patients following critical illness post-hospital discharge.
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Affiliation(s)
- Bronwen Connolly
- Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London SE1 9RT, UK
- Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Comprehensive Biomedical Research Centre, London SE1 9RT, UK
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, 3010 Australia
| | - Stephen Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Doug Elliott
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney, 2007 Australia
| | - Nicholas Hart
- Department of Asthma, Allergy and Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, London SE1 9RT, UK
- Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Comprehensive Biomedical Research Centre, London SE1 9RT, UK
- Lane Fox Respiratory Unit, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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125
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Ringdal M, Rose L. Recovery after critical illness: the role of follow-up services to improve psychological well-being. Can J Nurs Res 2012; 44:7-17. [PMID: 22679842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Zhang Z, Xu X, Ni H, Jin N. Serum cystatin C is associated with renal function recovery in critically ill patients undergoing continuous renal replacement therapy. Nephron Clin Pract 2012; 122:86-92. [PMID: 23594833 DOI: 10.1159/000350245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 02/14/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Serum cystatin C (sCyC) has long been known as a reliable biomarker of renal injury. However, it remains to be tested whether sCyC is a reliable biomarker to predict renal recovery after continuous renal replacement therapy (CRRT). METHODS A retrospective analysis of patients admitted to a tertiary 18-bed intensive care unit from January 2008 to December 2011 was performed. Univariate and multivariate regression analyses were performed to test the independent predictors of renal recovery. The diagnostic value of sCyC in predicting renal recovery was assessed using a receiver operating characteristic curve (ROC). RESULTS Older age and higher sCyC were independent risk factors of renal nonrecovery (OR: 1.40 and 4.76, respectively). The area under the ROC of sCyC to predict renal recovery was 0.87 (95% CI: 0.82-0.92), with a sensitivity and specificity of 80.5% and 83.5% at the cutoff of 2.98 mg/l. CONCLUSION A high sCyC level at the initiation of CRRT is associated with poor renal outcome.
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Affiliation(s)
- Z Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, China. zh_zhang184 @ hotmail.com
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127
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Brochard L, Jolliet P. [What's the usefulness of Intensive care/resuscitation unit in 2012?]. Rev Med Suisse 2011; 7:2427-2428. [PMID: 22279859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Affiliation(s)
- Brenda O'Neill
- Health and Rehabilitation Sciences Research Institute, School of Health Sciences, University of Ulster, Newtownabbey, Northern Ireland.
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129
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Elliott D, McKinley S, Alison J, Aitken LM, King M, Leslie GD, Kenny P, Taylor P, Foley R, Burmeister E. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care 2011; 15:R142. [PMID: 21658221 PMCID: PMC3219014 DOI: 10.1186/cc10265] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/27/2011] [Accepted: 06/09/2011] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery. METHODS A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge. RESULTS Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores. CONCLUSIONS This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register ACTRN12605000166673.
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Affiliation(s)
- Doug Elliott
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Sharon McKinley
- University of Technology, Sydney and Northern Sydney Local Health Network, Sydney,15 Broadway, Ultimo, 2007, Australia
| | - Jennifer Alison
- Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, Australia
| | - Leanne M Aitken
- Princess Alexandra Hospital and Griffith University, 199 Ipswich Road, Woolloongabba, 4102, Australia
| | - Madeleine King
- School of Psychology, University of Sydney, Fisher Road, Sydney, 2006, Australia
| | - Gavin D Leslie
- School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University and Royal Perth Hospital, Kent Street, Bentley, 6102, Australia
| | - Patricia Kenny
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Penny Taylor
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
| | - Rachel Foley
- Critical Care Nursing Professorial Unit, University of Technology, Sydney and Northern Sydney Local Health Network, 15 Broadway, Ultimo, 2007, Australia
| | - Elizabeth Burmeister
- Nursing Practice and Development Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia
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McFetridge B. Critical care rehabilitation--early and ongoing interventions in promoting recovery during and after critical illness. Special issue call for papers. Intensive Crit Care Nurs 2011; 27:57-9. [PMID: 21367604 DOI: 10.1016/j.iccn.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Fitzpatrick MA. Introduction. Crit Care Nurse 2010; 30:S2. [PMID: 20360442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Eldadah MK, Olsen MC, Fakioglu H, DeCampli WM. Transport of critically ill children on cardiopulmonary support assistance. J Extra Corpor Technol 2010; 42:80-83. [PMID: 20437797 PMCID: PMC4680071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 11/29/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To report two patients helicopter transport on mechanical cardiopulmonary support to a transplant center. SETTING Cardiac intensive care unit (CICU) and transport helicopter. PATIENTS A 9 kg and 22 kg children who suffer cardiac deterioration needing air transport on mechanical cardiopulmonary support. INTERVENTIONS AND RESULTS CPS was initiated to support these patients failing cardiac function. Transport on CPS of these two patients to a transplant institution was accomplished after determining that heart transplantation would be their more likely chance for recovery. CONCLUSION A cardiac deterioration event that will lead to the need for heart transplantation can be acute and sudden sparing no time for early referral to a transplant center. It is necessary for heart centers to have a plan of action to provide inter-hospital transport on cardiopulmonary support (CPS). This protocol can involve transport by the referral institution, the receiving institution or a third institution.
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Affiliation(s)
- Maher K Eldadah
- Congenital Heart Institute at Arnold Palmer Hospital for Children, Orlando, Florida 32806, USA
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139
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Leggett M, Harbrecht BG. Glucose control and its implications for the general surgeon. Am Surg 2009; 75:1031-1035. [PMID: 19927500 PMCID: PMC3471562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In the face of these conflicting data, how should the practicing surgeon approach the issue of tight glucose control in their critically ill surgical patients? The answer to that question may well change over time as new data emerge. For now, however, it seems reasonable to conclude that tight glucose control to the normal range (80-110 mg/dL) in critically ill general surgery patients (i.e., the Van den Berghe model) is an intriguing but unproven hypothesis that needs to be confirmed by prospective randomized trials in different ICUs and in a relevant patient population. It is quite possible, and probably likely, that levels of hyperglycemia that were previously thought to be inconsequential (180-200 mg/dL) may be harmful when sustained over prolonged periods of time and that better glucose control in the ICU than previously practiced is merited. However, given the detrimental effects of hypoglycemia, great care must be exercised in trying to achieve better glucose control so as not to induce harm. Technical considerations such as differences in glucose measuring systems, use of morning versus all glucose values, and nutritional regimens all need to be considered. The ICU is by definition a complex environment involving multiple teams of consulting specialists whose orders for medications, dialysis treatments, radiographic studies, and interruptions of enteral nutrition may all disrupt the ability to establish stable blood glucose levels. These factors need to be accounted for in daily clinical practice and their roles need to be better understood in future clinical trials. At present, it seems reasonable to attempt to control blood glucose levels in critically ill general surgery patients to moderate levels that avoid deleterious hypoglycemia but have been associated with encouraging clinical results until better data emerge. Until that time, the clinician will need to attempt to balance the potentially detrimental effects of hyperglycemia with the risk of hypoglycemia carefully until future trials involving general surgery patients are completed to clarify this issue.
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Affiliation(s)
- Maya Leggett
- Department of Surgery, University of Louisville, Louisville, KY 40292, USA
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141
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Proceedings of a Round Table Conference in Brussels, Belgium, March 2009, October 2009. Crit Care Med 2009; 37:S295-461. [PMID: 20183899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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de Jong AF, Kompanje EJO, Hofhuis JGM, Spronk PE, Schrijvers GAJP, Bakker J. Functional status after intensive care. J Rehabil Med 2009; 41:780; author reply 780-1. [PMID: 19774315 DOI: 10.2340/16501977-0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Poulsen JB, Møller K, Perner A. [Convalescence and decline in physical function level following intensive therapy]. Ugeskr Laeger 2009; 171:2916-2919. [PMID: 19814942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
More patients survive critical illness, which emphasises the need to assess outcome measures other than mortality. A prolonged decline in physical function is frequently observed after discharge in the critically ill. Neuromuscular dysfunction and muscle atrophy incurred during intensive care may prolong convalescence after discharge. Thus, strategies to counteract neuromuscular dysfunction and to improve physical outcome may reduce the overall burden of critical illness. This review describes the most common predisposing factors and discusses preventative measures and interventions.
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Affiliation(s)
- Jesper B Poulsen
- Intensiv Terapi Afsnit 4131, Abdominalcenteret, Rigshospitalet, DK-2100 København Ø, Denmark.
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Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373:1874-82. [PMID: 19446324 PMCID: PMC9906655 DOI: 10.1016/s0140-6736(09)60658-9] [Citation(s) in RCA: 1999] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. We assessed the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. METHODS Sedated adults (>/=18 years of age) in the ICU who had been on mechanical ventilation for less than 72 h, were expected to continue for at least 24 h, and who met criteria for baseline functional independence were eligible for enrolment in this randomised controlled trial at two university hospitals. We randomly assigned 104 patients by computer-generated, permuted block randomisation to early exercise and mobilisation (physical and occupational therapy) during periods of daily interruption of sedation (intervention; n=49) or to daily interruption of sedation with therapy as ordered by the primary care team (control; n=55). The primary endpoint-the number of patients returning to independent functional status at hospital discharge-was defined as the ability to perform six activities of daily living and the ability to walk independently. Therapists who undertook patient assessments were blinded to treatment assignment. Secondary endpoints included duration of delirium and ventilator-free days during the first 28 days of hospital stay. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00322010. FINDINGS All 104 patients were included in the analysis. Return to independent functional status at hospital discharge occurred in 29 (59%) patients in the intervention group compared with 19 (35%) patients in the control group (p=0.02; odds ratio 2.7 [95% CI 1.2-6.1]). Patients in the intervention group had shorter duration of delirium (median 2.0 days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p=0.02), and more ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days, 0.0-23.8; p=0.05) during the 28-day follow-up period than did controls. There was one serious adverse event in 498 therapy sessions (desaturation less than 80%). Discontinuation of therapy as a result of patient instability occurred in 19 (4%) of all sessions, most commonly for perceived patient-ventilator asynchrony. INTERPRETATION A strategy for whole-body rehabilitation-consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness-was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care. FUNDING None.
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Affiliation(s)
- William D Schweickert
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jones C. Nurses' role in helping to rehabilitate patients to return to health after critical illness. Nurs Times 2009; 105:14. [PMID: 19544980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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147
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Affiliation(s)
- Toni Tan
- Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester M1 4BD
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148
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Piaggi G. [Physical reconditioning of critical respiratory patients]. G Ital Med Lav Ergon 2009; 31:101-106. [PMID: 19558045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Debaveye Y, Ellger B, Mebis L, Visser TJ, Darras VM, Van den Berghe G. Effects of substitution and high-dose thyroid hormone therapy on deiodination, sulfoconjugation, and tissue thyroid hormone levels in prolonged critically ill rabbits. Endocrinology 2008; 149:4218-28. [PMID: 18450965 PMCID: PMC2488214 DOI: 10.1210/en.2007-1566] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To delineate the metabolic fate of thyroid hormone in prolonged critically ill rabbits, we investigated the impact of two dose regimes of thyroid hormone on plasma 3,3'-diiodothyronine (T(2)) and T(4)S, deiodinase type 1 (D1) and D3 activity, and tissue iodothyronine levels in liver and kidney, as compared with saline and TRH. D2-expressing tissues were ignored. The regimens comprised either substitution dose or a 3- to 5- fold higher dose of T(4) and T(3), either alone or combined, targeted to achieve plasma thyroid hormone levels obtained by TRH. Compared with healthy animals, saline-treated ill rabbits revealed lower plasma T(3) (P=0.006), hepatic T(3) (P=0.02), and hepatic D1 activity (P=0.01). Substitution-dosed thyroid hormone therapy did not affect these changes except a further decline in plasma (P=0.0006) and tissue T(4) (P=0.04). High-dosed thyroid hormone therapy elevated plasma and tissue iodothyronine levels and hepatic D1 activity, as did TRH. Changes in iodothyronine tissue levels mimicked changes in plasma. Tissue T(3) and tissue T(3)/reverse T(3) ratio correlated with deiodinase activities. Neither substitution- nor high-dose treatment altered plasma T(2). Plasma T(4)S was increased only by T(4) in high dose. We conclude that in prolonged critically ill rabbits, low plasma T(3) levels were associated with low liver and kidney T(3) levels. Restoration of plasma and liver and kidney tissue iodothyronine levels was not achieved by thyroid hormone in substitution dose but instead required severalfold this dose. This indicates thyroid hormone hypermetabolism, which in this model of critical illness is not entirely explained by deiodination or by sulfoconjugation.
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Affiliation(s)
- Yves Debaveye
- Department of Intensive Care Medicine, Catholic University of Leuven, B-3000 Leuven, Belgium
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Van de Meent H, Baken BCM, Van Opstal S, Hogendoorn P. Critical illness VR rehabilitation device (X-VR-D): Evaluation of the potential use for early clinical rehabilitation. J Electromyogr Kinesiol 2008; 18:480-6. [PMID: 17223575 DOI: 10.1016/j.jelekin.2006.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 10/27/2006] [Accepted: 11/14/2006] [Indexed: 11/27/2022] Open
Abstract
We present a new critical illness VR rehabilitation device (X-VR-D) that enables diversified self-training and is applicable early in the rehabilitation of severely injured or ill patients. The X-VR-D consists of a VR program delivering a virtual scene on a flat screen and simultaneously processing commands to a moving chair mounted on a motion system. Sitting in the moving chair and exposed to a virtual reality environment the device evokes anticipatory and reactive muscle contractions in trunk and extremities for postural control. In this study we tested the device in 10 healthy subjects to evaluate whether the enforced perturbations indeed evoke sufficient and reproducible EMG muscle activations. We found that particular fast roll and pitch movements evoke adequate trunk and leg muscle activity. Higher angular velocities and higher angles of inclination elicited broader EMG bursts and larger amplitudes. The muscle activation pattern was highly consistent between different subjects and although we found some habituation of EMG responses in consecutive training sessions, the general pattern was maintained and was predictable for specific movements. The habituation was characterized by more efficient muscle contractions and better muscle relaxation during the rest positions of the device. Furthermore we found that the addition of a virtual environment to the training session evoked more preparatory and anticipatory muscle activation than sessions without a virtual environment. We conclude that the X-VR-D is safe and effective to elicit consistent and reproducible muscle activity in trunk and leg muscles in healthy subjects and thus can be used as a training method.
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Affiliation(s)
- H Van de Meent
- University Medical Centre St Radboud, Department of Rehabilitation Medicine, Reinierpostlaan 4, POB 9191, Postal code 6500 HB Nijmegen, The Netherlands.
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