Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

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

Authors: Clément Medrinal, Yann Combret, Guillaume Prieur, Aurora Robledo Quesada, Tristan Bonnevie, Francis Edouard Gravier, Elise Dupuis Lozeron, Eric Frenoy, Olivier Contal, Bouchra Lamia

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

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.
Literature
1.
Denehy L, Lanphere J, Needham DM. Ten reasons why ICU patients should be mobilized early. Intensive Care Med. 2017;43:86–90.CrossRefPubMed
2.
Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37:2499–505.CrossRefPubMed
3.
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.CrossRefPubMed
4.
Routsi C, Gerovasili V, Vasileiadis I, et al. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Care. 2010;14:R74.CrossRefPubMedPubMedCentral
5.
Castro-Avila AC, Seron P, Fan E, et al. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis. PLoS One. 2015;10:e0130722.CrossRefPubMedPubMedCentral
6.
Hodgson C, Bellomo R, Berney S, et al. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care. 2015;19:81.CrossRefPubMed
7.
Morris PE, Berry MJ, Files DC, et al. Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. JAMA. 2016;315:2694–702.CrossRefPubMed
8.
Moss M, Nordon-Craft A, Malone D, et al. A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med. 2016;193:1101–10.CrossRefPubMedPubMedCentral
9.
Wright SE, Thomas K, Watson G, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2017;73:213–21.CrossRefPubMedPubMedCentral
10.
Nydahl P, Ruhl AP, Bartoszek G, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42:1178–86.CrossRefPubMed
11.
Connolly BA, Mortimore JL, Douiri A, et al. Low levels of physical activity during critical illness and weaning: the evidence-reality gap. J Intensive Care Med. 2017:885066617716377.
12.
Berney SC, Rose JW, Bernhardt J, et al. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care. 2015;30:658–63.CrossRefPubMed
13.
Jolley SE, Moss M, Needham DM, et al. Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med. 2017;45:205–15.CrossRefPubMedPubMedCentral
14.
Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med. 2017;43:531–42.CrossRefPubMed
15.
Forton K, Motoji Y, Deboeck G, et al. Effects of body position on exercise capacity and pulmonary vascular pressure-flow relationships. J Appl Physiol (1985). 2016;121(5):1145–50.CrossRef
16.
Kovacs G, Herve P, Barbera JA, et al. An official European Respiratory Society statement: pulmonary haemodynamics during exercise. Eur Respir J. 2017;50(5)
17.
Trinity JD, Lee JF, Pahnke MD, et al. Attenuated relationship between cardiac output and oxygen uptake during high-intensity exercise. Acta Physiol (Oxford). 2012;204(3):362–70.CrossRef
18.
Gormley SE, Swain DP, High R, et al. Effect of intensity of aerobic training on VO2max. Med Sci Sports Exerc. 2008;40:1336–43.CrossRefPubMed
19.
Hickmann CE, Roeseler J, Castanares-Zapatero D, et al. Energy expenditure in the critically ill performing early physical therapy. Intensive Care Med. 2014;40(4):548–55.CrossRefPubMed
20.
Medrinal C, Combret Y, Prieur G, et al. Effects of different early rehabilitation techniques on haemodynamic and metabolic parameters in sedated patients: protocol for a randomised, single-bind, cross-over trial. BMJ Open Respir Res. 2017;4:e000173.CrossRefPubMedPubMedCentral
21.
Lamia B, Ochagavia A, Monnet X, et al. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med. 2007;33:1125–32.CrossRefPubMed
22.
Lamia B, Teboul JL, Monnet X, et al. Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients. Intensive Care Med. 2007;33:1931–7.CrossRefPubMed
23.
Naeije R, Saggar R, Badesch D, et al. Exercise-Induced pulmonary hypertension: translating pathophysiological concepts into clinical practice. Chest. 2018;(18):30161–2.
24.
Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139–45.CrossRefPubMed
25.
Bourdin G, Barbier J, Burle JF, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55:400–7.PubMed
26.
Parry SM, Berney S, Warrillow S, et al. Functional electrical stimulation with cycling in the critically ill: a pilot case-matched control study. J Crit Care. 2014;29(695):e691–7.
27.
Muraki S, Fornusek C, Raymond J, et al. Muscle oxygenation during prolonged electrical stimulation-evoked cycling in paraplegics. Appl Physiol Nutr Metab. 2007;32:463–72.CrossRefPubMed
28.
Camargo Pires-Neto R, Fogaca Kawaguchi YM, Sayuri Hirota A, et al. Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects–a case series. PLoS One. 2013;8:e74182.CrossRefPubMedPubMedCentral
29.
30.
Gerovasili V, Stefanidis K, Vitzilaios K, et al. Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study. Crit Care. 2009;13:R161.CrossRefPubMedPubMedCentral
31.
Parry SM, Berney S, Granger CL, et al. Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med. 2013;41:2406–18.CrossRefPubMed
32.
Gruther W, Kainberger F, Fialka-Moser V, et al. Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study. J Rehabil Med. 2010;42:593–7.CrossRefPubMed
33.
Weber-Carstens S, Schneider J, Wollersheim T, et al. Critical illness myopathy and GLUT4-significance of insulin and muscle contraction. Am J Respir Crit Care Med. 2013;187(4):387–96.CrossRefPubMed
34.
Ferreira LF, Koga S, Barstow TJ. Dynamics of noninvasively estimated microvascular O2 extraction during ramp exercise. J Appl Physiol. 2007;103:1999–2004.CrossRefPubMed
35.
Van Beekvelt MC, Colier WN, Wevers RA, et al. Performance of near-infrared spectroscopy in measuring local O(2) consumption and blood flow in skeletal muscle. J Appl Physiol. 2001;90:511–9.CrossRefPubMed
36.
Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016;42:1935–47.CrossRefPubMed
37.
Nobrega AC, Williamson JW, Friedman DB, et al. Cardiovascular responses to active and passive cycling movements. Med Sci Sports Exerc. 1994;26:709–14.CrossRefPubMed
38.
Gerovasili V, Tripodaki E, Karatzanos E, et al. Short-term systemic effect of electrical muscle stimulation in critically ill patients. Chest. 2009;136:1249–56.CrossRefPubMed
39.
Angelopoulos E, Karatzanos E, Dimopoulos S, et al. Acute microcirculatory effects of medium frequency versus high frequency neuromuscular electrical stimulation in critically ill patients - a pilot study. Ann Intensive Care. 2013;3:39.CrossRefPubMedPubMedCentral
40.
Subudhi AW, Dimmen AC. Roach RC. Effects of acute hypoxia on cerebral and muscle oxygenation during incremental exercise. J Appl Physiol. 2007;103:177–83.CrossRefPubMed
41.
Fan E, Cheek F, Chlan L, et al. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014;190:1437–46.CrossRefPubMed
42.
Latronico N, Herridge M, Hopkins RO, et al. The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Med. 2017;43:1270–81.CrossRefPubMed
43.
Neary JP. Application of near infrared spectroscopy to exercise sports science. Can J Appl Physiol. 2004;29:488–503.CrossRefPubMed
Metadata
Title
Comparison of exercise intensity during four early rehabilitation techniques in sedated and ventilated patients in ICU: a randomised cross-over trial
Authors
Clément Medrinal
Yann Combret
Guillaume Prieur
Aurora Robledo Quesada
Tristan Bonnevie
Francis Edouard Gravier
Elise Dupuis Lozeron
Eric Frenoy
Olivier Contal
Bouchra Lamia
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2030-0

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Review

Acute exacerbation of idiopathic pulmonary fibrosis: lessons learned from acute respiratory distress syndrome?

Research

Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia

Letter

Comparing fiberoptic bronchoscopy and a tracheal tube-mounted camera-guided percutaneous dilatational tracheostomy: authors' reply

Letter

The choice of a postpyloric tube and the patient’s position in our procedure: A response

Review

Hemodynamic effects of acute hyperoxia: systematic review and meta-analysis

Research

Carbonic anhydrase inhibitors in patients with respiratory failure and metabolic alkalosis: a systematic review and meta-analysis of randomized controlled trials