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Küçük AO, Hatınoğlu N, Apaydin U, Altunalan T, Küçük MP. The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study. Nurs Crit Care 2024. [PMID: 39449552 DOI: 10.1111/nicc.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 09/26/2024] [Accepted: 10/11/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay. AIM This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD). STUDY DESIGN This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises. RESULTS The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η2: 0.025, ONSD left eye p:.935, Partial η2: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η2: 0.009, Systolic Pressure p:.435, Partial η2: 0.043, Diastolic Pressure p:.128, Partial η2:0.103, Saturation p:.103, Partial η2: 0.113 and Respiratory rate p:.071, Partial η2:0.130). CONCLUSION This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy. RELEVANCE TO CLINICAL PRACTICE Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.
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Affiliation(s)
- Ahmet Oğuzhan Küçük
- Department of Pulmonary Diseases, Division of Intensive Care Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
- Department of Computer Science, Faculty of Science, Karadeniz Technical University, Trabzon, Türkiye
| | - Neslihan Hatınoğlu
- Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
| | - Umut Apaydin
- Department of Physical Therapy and Rehabilitation, Health Science Faculty, Karadeniz Technical University, Trabzon, Türkiye
| | - Turgay Altunalan
- Department of Physical Therapy and Rehabilitation, Health Science Faculty, Karadeniz Technical University, Trabzon, Türkiye
| | - Mehtap Pehlivanlar Küçük
- Department of Pulmonary Diseases, Division of Intensive Care Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
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Physiotherapy in the neurotrauma intensive care unit: A scoping review. J Crit Care 2018; 48:390-406. [PMID: 30316038 DOI: 10.1016/j.jcrc.2018.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/20/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted included purpose, study design, population (s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries are presented by intervention type. RESULTS 12,846 titles were screened and 72 met the inclusion criteria. Most of the studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). Early mobilization, electrical stimulation, range of motion, and chest physiotherapy techniques were the most common interventions in the literature. Physiotherapy interventions were found to be safe with few adverse events. CONCLUSIONS Gaps in the literature suggest that future studies require assessment of long term functional outcomes and quality of life, examination of homogenous populations and more robust methodologies including clinical trials and larger samples.
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Thelandersson A, Nellgård B, Ricksten SE, Cider Å. Effects of Early Bedside Cycle Exercise on Intracranial Pressure and Systemic Hemodynamics in Critically Ill Patients in a Neurointensive Care Unit. Neurocrit Care 2017; 25:434-439. [PMID: 27216931 DOI: 10.1007/s12028-016-0278-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU). METHODS Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital. One early implemented exercise session was performed using a bedside cycle ergometer for 20 min. Intracranial and hemodynamic variables were measured two times before, three times during, and two times after the bedside cycling exercise. Analyzed variables were intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The cycling intervention was conducted within 7 ± 5 days after admission to the NICU. RESULTS Cycle exercise increased MAP (p = 0.029) and SV (p = 0.003) significantly. After exercise CO, SV, MAP, and CPP decreased significantly, while no changes in HR, SVV, SpO2, or ICP were noted when compared to values obtained during exercise. There were no differences in data obtained before versus after exercise. CONCLUSION Early implemented exercise with a bedside cycle ergometer, for patients with severe brain injuries or stroke when admitted to a NICU, is considered to be a clinically safe procedure.
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Affiliation(s)
- Anneli Thelandersson
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden. .,Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Bengt Nellgård
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Cider
- Institute of Physiology and Neuroscience, Department of Health and Rehabilitation/Physiotherapy, Gothenburg University, Gothenburg, Sweden.,Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pinheiro TT, de Freitas FGR, Coimbra KTF, Mendez VMF, Rossetti HB, Talma PV, Bafi AT, Machado FR. Short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock. Ann Intensive Care 2017; 7:95. [PMID: 28887766 PMCID: PMC5591179 DOI: 10.1186/s13613-017-0318-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/30/2017] [Indexed: 01/09/2023] Open
Abstract
Background Active mobilization is not possible in patients under deep sedation and unable to follow commands. In this scenario, passive therapy is an interesting alternative. However, in patients with septic shock, passive mobilization may have risks related to increased oxygen consumption. Our objective was to evaluate the impact of passive mobilization on sublingual microcirculation and systemic hemodynamics in patients with septic shock. Methods We included patients who were older than 18 years, who presented with septic shock, and who were under sedation and mechanical ventilation. Passive exercise was applied for 20 min with 30 repetitions per minute. Systemic hemodynamic and microcirculatory variables were compared before (T0) and up to 10 min after (T1) passive exercise. p values <0.05 were considered significant. Results We included 35 patients (median age [IQR 25–75%]: 68 [49.0–78.0] years; mean (±SD) Simplified Acute Physiologic Score (SAPS) 3 score: 66.7 ± 12.1; median [IQR 25–75%] Sequential Organ Failure Assessment (SOFA) score: 9 [7.0–12.0]). After passive mobilization, there was a slight but significant increase in proportion of perfused vessels (PPV) (T0 [IQR 25–75%]: 78.2 [70.9–81.9%]; T1 [IQR 25–75%]: 80.0 [75.2–85.1] %; p = 0.029), without any change in other microcirculatory variables. There was a reduction in heart rate (HR) (T0 (mean ± SD): 95.6 ± 22.0 bpm; T1 (mean ± SD): 93.8 ± 22.0 bpm; p < 0.040) and body temperature (T0 (mean ± SD): 36.9 ± 1.1 °C; T1 (mean ± SD): 36.7 ± 1.2 °C; p < 0.002) with no change in other systemic hemodynamic variables. There was no significant correlation between PPV variation and HR (r = −0.010, p = 0.955), cardiac index (r = 0.218, p = 0.215) or mean arterial pressure (r = 0.276, p = 0.109) variation. Conclusions In patients with septic shock after the initial phase of hemodynamic resuscitation, passive exercise is not associated with relevant changes in sublingual microcirculation or systemic hemodynamics. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0318-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tuanny Teixeira Pinheiro
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Flávio Geraldo Rezende de Freitas
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil.
| | - Karla Tuanny Fiorese Coimbra
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Vanessa Marques Ferreira Mendez
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Heloísa Baccaro Rossetti
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Paulo Vinicius Talma
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Antônio Tonete Bafi
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
| | - Flávia Ribeiro Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of Sao Paulo, Napoleão de Barros 737, Sao Paulo, SP, 04024002, Brazil
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Amidei C, Sole ML. Physiological responses to passive exercise in adults receiving mechanical ventilation. Am J Crit Care 2013; 22:337-48. [PMID: 23817823 DOI: 10.4037/ajcc2013284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Critical illness may weaken muscles, with long-term consequences. OBJECTIVE To assess physiological responses to an early standardized passive exercise protocol to prevent muscle weakness in adults receiving mechanical ventilation. METHODS A quasi-experimental within-subjects repeated-measures design was used. Within 72 hours of intubation, 30 patients had 20 minutes of bilateral passive leg movement delivered by continuous-passive-motion machines at a standardized rate and flexion-extension. Heart rate, mean blood pressure, oxygen saturation, and cytokine levels were measured before, during, and after the intervention. The Behavioral Pain Scale was used to measure patients' comfort. Repeated-measures analysis of variance was used to analyze the effect of the exercise on independent variables. RESULTS Patients were mostly white men with a mean age of 56.5 years (SD, 16.9) with moderate mortality risk and illness severity. Heart rate, mean blood pressure, and oxygen saturation did not differ from baseline at any time measured. Pain scores were significantly reduced (F(2.43,70.42) = 4.08; P = .02) 5 and 10 minutes after exercise started and remained reduced at the end of exercise and 1 hour later. Interleukin 6 levels were significantly reduced (F(1.60,43.1) = 4.35; P = .03) at the end of exercise but not after the final rest period. Interleukin 10 levels did not differ significantly. Ratios of interleukin 6 to interleukin 10 decreased significantly (F(1.61,43.38) = 3.42; P = .05) at the end of exercise and again after 60 minutes' rest. CONCLUSION The exercise was well tolerated, and comfort improved during and after the intervention. Cytokine levels provided physiological rationale for benefits of early exercise.
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Affiliation(s)
- Christina Amidei
- Christina Amidei is an advanced practice research nurse, Department of Neuro-Oncology, University of Chicago, Chicago, Illinois. Mary Lou Sole is a professor, University of Central Florida, College of Nursing, Orlando, Florida
| | - Mary Lou Sole
- Christina Amidei is an advanced practice research nurse, Department of Neuro-Oncology, University of Chicago, Chicago, Illinois. Mary Lou Sole is a professor, University of Central Florida, College of Nursing, Orlando, Florida
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Roth C, Stitz H, Kalhout A, Kleffmann J, Deinsberger W, Ferbert A. Effect of Early Physiotherapy on Intracranial Pressure and Cerebral Perfusion Pressure. Neurocrit Care 2012. [DOI: 10.1007/s12028-012-9799-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thelandersson A, Volkmann R, Cider A. Blood flow velocity and vascular resistance during passive leg exercise in the critically ill patient. Clin Physiol Funct Imaging 2012; 32:338-42. [PMID: 22856339 DOI: 10.1111/j.1475-097x.2012.01132.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
Abstract
Passive range of motion exercise is a very common physical therapy treatment for patients admitted to an intensive care unit. However is the knowledge scarce regarding its impact on blood circulation in the extremities. The objective of this study was therefore to investigate the effect of passive range of motion on arterial peripheral leg blood flow velocity (BFV) and vascular resistance. A cross-sectional consecutive study of twelve patients admitted to an intensive care unit and twelve healthy age- and gender-matched controls was conducted. Passive range of motion was performed in one leg by a physical therapist. Blood flow velocities and resistance index in the common femoral artery (CFA), blood pressure and heart rate were measured before, directly after and at rest after passive range of motion. No changes were seen in BFV or resistance index in the patient group or the control group. No changes were found in blood pressure or heart rate in the patient group. In the control group, changes were found in systolic and mean blood pressure, with a higher pressure before passive range of motion. The controls had lower BFV and higher resistance index than the patients when comparing the groups. The conclusion of this study including twelve patients is that passive range of motion does not alter BFV or resistance index in the CFA in comatose and/or sedated critically ill patients.
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Affiliation(s)
- Anneli Thelandersson
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Amidei C. Measurement of physiologic responses to mobilisation in critically ill adults. Intensive Crit Care Nurs 2012; 28:58-72. [PMID: 22390919 DOI: 10.1016/j.iccn.2011.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/11/2011] [Accepted: 09/16/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify physiologic variables that could be measured in response to mobilisation interventions in critically ill adults. BACKGROUND Physical activity may mitigate muscle damage from critical illness, but critically ill patients may have limited activity tolerance. Physiologic measures may be most useful in identifying safety and efficacy of mobilisation in this population. METHODS A comprehensive literature search of electronic databases was conducted from 1990 to present, including CINAHL, MEDLINE the Cochrane Database of Systematic Reviews and PubMed. Search terms used were mobilisation, exercise, activity and critical illness. Seventeen articles were identified for review. Physiologic measurement approaches were reviewed for precision and accuracy. RESULTS Cardiopulmonary measures comprised the majority of physiologic variables identified, and multiple measures were used. Physiologic measures were primarily used as indicators of safety, although several efficacy measures were identified. Only one standardised tool was found that could be suitable as a safety measure, the Borg Rating of Perceived Exertion. The Medical Research Council Muscle Strength Grading Scale could be used as a physiologic outcome measure. Inflammatory biomarkers may be used as a novel measure of physiologic response. Descriptions of approaches to assure precision and accuracy of physiologic response measures were extremely limited. CONCLUSIONS Multiple physiologic variables should be measured when considering response to mobilisation in critically ill patients. Attention should be paid to procedures to assure accuracy and precision in measurement. Future studies including physiologic measures should include inflammatory biomarkers, and other measures of physiologic function, such as pain assessment.
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Affiliation(s)
- Christina Amidei
- University of Central Florida, College of Nursing, Orlando, FL 32816, United States.
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