Comparison of exercise intensity during four early rehabilitation techniques in sedated and ventilated patients in ICU : a randomised cross-over trial

Medrinal, Clément (Normandie Univ, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, Montivilliers, France) ; Combret, Yann (Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium ; Physiotherapy Department, Groupe Hospitalier du Havre, avenue Pierre Mendes France, Montivilliers, France) ; Prieur, Guillaume (Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, Montivilliers, France) ; Robledo Quesada, Aurora (Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, Montivilliers, France) ; Bonnevie, Tristan (Normandie Univ, UNIROUEN, EA3830 – GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; ADIR Association, Bois Guillaume, France) ; Gravier, Francis Edouard (ADIR Association, Bois Guillaume, France) ; Dupuis Lozeron, Elise (Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland) ; Frenoy, Eric (Intensive Care Unit Department Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Montivilliers, France) ; Contal, Olivier (HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland) ; Lamia, Bouchra (Normandie Univ, UNIROUEN, EA3830 – GRHV, Rouen, France ; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France ; Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France ; Pulmonology Department, Groupe Hospitalier du Havre, avenue Pierre Mendes France, Montivilliers, France)

Background In the ICU, out-of-bed rehabilitation is often delayed and in-bed exercises are generally low-intensity. Since the majority of rehabilitation is carried out in bed, it is essential to carry out the exercises that have the highest intensity. The aim of this study was to compare the physiological effects of four common types of bed exercise in intubated, sedated patients confined to bed in the ICU, in order to determine which was the most intensive. Methods A randomised, single-blind, placebo-controlled crossover trial was carried out to evaluate the effects of four bed exercises (passive range of movements (PROM), passive cycle-ergometry, quadriceps electrical stimulation and functional electrical stimulation (FES) cycling) on cardiac output. Each exercise was carried out for ten minutes in ventilated, sedated patients. Cardiac output was recorded using cardiac Doppler ultrasound. The secondary aims were to evaluate right heart function and pulmonary and systemic artery pressures during the exercises, and the microcirculation of the vastus lateralis muscle. Results The results were analysed in 19 patients. FES cycling was the only exercise that increased cardiac output, with a mean increase of 1 L/min (15%). There was a concomitant increase in muscle oxygen uptake, suggesting that muscle work occurred. FES cycling thus constitutes an effective early rehabilitation intervention. No muscle or systemic effects were induced by the passive techniques. Conclusion Most bed exercises were low-intensity and induced low levels of muscle work. FES cycling was the only exercise that increased cardiac output and produced sufficient intensity of muscle work. Longer-term studies of the effect of FES cycling on functional outcomes should be carried out. Trial registration ClinicalTrials.gov, NCT02920684. Registered on 30 September 2016. Prospectively registered.


Keywords:
Article Type:
scientifique
Faculty:
Santé
Branch:
Physiothérapie
School:
HESAV
Institute:
Unité de recherche en santé, HESAV
Subject(s):
Santé
Date:
2018-04
Pagination:
8 p.
Published in:
Critical care
Numeration (vol. no.):
April 2018, vol. 22, art. 110
DOI:
ISSN:
1364-8535
Appears in Collection:



 Record created 2019-03-13, last modified 2019-03-14

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