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Jalil Y, Damiani LF, García-Valdés P, Basoalto R, Gallastegui J, Gutierrez-Arias R. Myokine Secretion Dynamics and Their Role in Critically Ill Patients: A Scoping Review. J Clin Med 2025; 14:2892. [PMID: 40363924 PMCID: PMC12072662 DOI: 10.3390/jcm14092892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 01/28/2025] [Accepted: 02/10/2025] [Indexed: 05/10/2025] Open
Abstract
Background/Objectives: Myokines can modulate organ function and metabolism, offering a protective profile against ICU complications beyond preventing local muscle wasting. This scoping review aims to explore and summarize the evidence regarding the secretion of myokines and their potential local or systemic effects in critically ill patients. Methods: A scoping review following Joana Briggs Institute recommendations was conducted. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, CINAHL (EBSCOhost), WoS, and Scopus was conducted from inception to February 2023. We included primary studies evaluating myokine secretion/concentration in critically ill adults undergoing physical rehabilitation interventions. Two independent reviewers performed study selection and data extraction. Results: Seventeen studies published between 2012 and 2023 were included. Most were randomized clinical trials (47%). Physical rehabilitation interventions included electrical muscle stimulation, as well as passive and active mobilization, delivered alone or combined, in single or daily sessions lasting 20-60 min. Twelve studies (70%) evaluated interleukin-6, while interleukin-10, tumour necrosis factor-α, Interleukin-8, and myostatin were also commonly studied. Thirteen studies (76%) reported changes in myokine secretion or gene expression, although no clear concentration change pattern emerged. Myokines involved in muscle protein synthesis and breakdown may protect against muscle waste and weakness. Conclusions: The study of myokine dynamics in critically ill patients highlights the systemic impact of physical rehabilitation. This emerging field has grown in interest over the past decade, offering significant research potential. However, challenges such as study design, small sample sizes, and variability in physical therapy protocols hinder a comprehensive understanding of myokine responses.
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Affiliation(s)
- Yorschua Jalil
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - L. Felipe Damiani
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - Patricio García-Valdés
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Roque Basoalto
- CardioREspirAtory Research Laboratory, Departamento Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Department of Intensive Care Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile
| | - Julen Gallastegui
- Escuela de Ciencias de la Salud, Departamento de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 1270709, Chile; (Y.J.); (L.F.D.); (P.G.-V.); (J.G.)
| | - Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago 8320000, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago 8320000, Chile
- Faculty of Rehabilitation Sciences, Exercise and Rehabilitation Sciences Institute, Universidad Andres Bello, Santiago 7591538, Chile
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Choi AY, Kim MY, Song EK. [Effect of an Intervention Using Voice Recording of a Family Member on Patients Undergoing Mechanical Ventilator Weaning Process]. J Korean Acad Nurs 2024; 54:32-43. [PMID: 38480576 DOI: 10.4040/jkan.23082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE This study aimed to determine the impact of an intervention using voice recording of family members on pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. METHODS A randomized control pre-post experimental design was implemented to 53 participants, with 27 and 26 participants in the experimental and control groups, respectively. A 70-second voice recording of a family member, repeated three times at 10-minute intervals was used as an intervention for the experimental group. Meanwhile, participants in the control group used headset for 30 minutes. Structured instruments were utilized to measure pain, anxiety, agitation, and the weaning process. Wilcoxon Signed Ranks test and the Mann-Whitney U test, or χ² test, were used for data analysis. RESULTS The experimental group exhibited significant decrease in pain (Z = -3.53, p < .001), anxiety (t = 5.45, p < .001), and agitation (Z = -2.99, p = .003) scores compared with those of the control group. However, there was no significant difference between groups in the weaning process' simplification (χ² = 0.63, p = .727). CONCLUSION Intervention using family members' voice recording effectively reduces pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. This can be actively utilized to provide a more comfortable process for patients.
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Affiliation(s)
- Ah Young Choi
- Emergency Intensive Care Unit, Ulsan University Hospital, Ulsan, Korea
| | - Min Young Kim
- Department of Nursing, Ulsan University, Ulsan, Korea.
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Vollenweider R, Manettas AI, Häni N, de Bruin ED, Knols RH. Passive motion of the lower extremities in sedated and ventilated patients in the ICU - a systematic review of early effects and replicability of Interventions. PLoS One 2022; 17:e0267255. [PMID: 35552550 PMCID: PMC9098053 DOI: 10.1371/journal.pone.0267255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 04/05/2022] [Indexed: 01/02/2023] Open
Abstract
Early mobilization, which includes active / passive motion in bed along with mobilization out of bed, is recommended to prevent the development of intensive care unit acquired-weakness (ICU-AW) for patients with critical illness on the intensive care unit. To date, the impact of passive motion of the lower extremities in sedated and ventilated patients remains unclear. The aim of the study is to systematically review and summarize the currently available randomized controlled trials in English or German language on the impact of passive motion of the lower extremities in sedated and ventilated patients ≥ 18 years in the intensive care unit on musculature, inflammation and immune system and the development of intensive care unit-acquired weakness and to evaluate the replicability of interventions and the methodological quality of included studies. A systematic literature search was performed up to 20th February 2022 in the databases Medline, Embase, Cochrane Library, CINAHL and PEDro. The description of the intervention (TIDieR checklist) and the methodological quality (Downs and Black checklist) were assessed. Five studies were included in the qualitative syntheses. On average, the studies were rated with 6.8 out of 12 points according to the TIDieR checklist. For the methodological quality an average of 19.8 out of 27 points on the Downs and Black checklist was reported. The results of included studies indicated that muscle loss may be reduced by passive manual movement, passive cycling and passive motion on a continuous passive motion-unit. In addition, positive effects were reported on the reduction of nitrosative stress and the immune response. The impact on the development of ICU-AW remains unclear. In conclusion, passive movement show a slight tendency for beneficial changes on cellular level in sedated and ventilated patients in the ICU within the first days of admission, which may indicate a reduction of muscle wasting and could prevent the development of ICU-AW. Future randomized controlled trials should use larger samples, use complete intervention description, use a comparable set of outcome measures, use rigorous methodology and examine the effect of passive motion on the development of ICU-AW.
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Affiliation(s)
- Rahel Vollenweider
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios I. Manettas
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Nathalie Häni
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- OST–Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
| | - Ruud H. Knols
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
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Kourek C, Nanas S, Kotanidou A, Raidou V, Dimopoulou M, Adamopoulos S, Karabinis A, Dimopoulos S. Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support. J Cardiovasc Dev Dis 2022; 9:34. [PMID: 35200688 PMCID: PMC8875180 DOI: 10.3390/jcdd9020034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with severe cardiac, respiratory or combined cardiorespiratory failure. Critically ill patients on ECMO very often present intensive care unit-acquired weakness (ICU-AW); thus, leading to decreased exercise capacity and increased mortality rates. Early mobilization and physical therapy have been proven to be safe and feasible in critically ill patients on ECMO, either as a bridge to lung/heart transplantation or as a bridge to recovery. Rehabilitation has beneficial effects from the early stages in the ICU, resulting in the prevention of ICU-AW, and a decrease in episodes of delirium, the duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates. It also improves functional ability, exercise capacity, and quality of life. Rehabilitation requires a very careful, multi-disciplinary approach from a highly specialized team from different specialties. Initial risk assessment and screening, with appropriate physical therapy planning and exercise monitoring in patients receiving ECMO therapy are crucial factors for achieving treatment goals. However, more randomized controlled trials are required in order to establish more appropriate individualized exercise training protocols.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Anastasia Kotanidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Maria Dimopoulou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
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Alaparthi GK, Raigangar V, Chakravarthy Bairapareddy K, Gatty A, Mohammad S, Alzarooni A, Atef M, Abdulrahman R, Redha S, Rashid A, Tamim M. A national survey in United Arab Emirates on practice of passive range of motion by physiotherapists in intensive care unit. PLoS One 2021; 16:e0256453. [PMID: 34415966 PMCID: PMC8378748 DOI: 10.1371/journal.pone.0256453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients admitted to intensive care units (ICU) are at an increased risk of developing immobility related complications. Physiotherapists are challenged to employ preventive and rehabilitative strategies to combat these effects. Passive limb range of motion (PROM) exercises- a part of early mobilization-aid in maintaining joint range of motion and functional muscle strength and forms a part of treatment for patients in ICU. However, there is a lack of evidence on practice of PROM exercises on patients admitted to ICU in the United Arab Emirates (UAE). This study aimed at exploring practices regarding the same in UAE. METHODS This survey, conducted from January 2021 to February 2021 in College of Physiotherapy, Sharjah University studied practice of physiotherapists in the intensive care units. Physiotherapists currently working in ICU completed an online questionnaire composed of forty-two questions about physiotherapy service provision, assessment and intervention in the intensive care units. RESULTS 33 physiotherapists completed the survey. 66.6% of respondents routinely assessed PROM for all the patients in ICU referred for physiotherapy. 84.8% of them assessed all the joints. More than half of the respondents (57.8%) reported that they administered PROM regularly to all the patients. According to 63.6% respondents, maintaining joint range of motion was the main reason for performing PROM. Responses pertaining to sets and repetitions of PROM were variable ranging from 1-6 sets and from 3 to 30 repetitions. Personal experience, resources/financial consideration and research findings were found to have influence on the practice. CONCLUSIONS PROM was found to be one of the frequently used mobilization techniques administered by physiotherapists in the intensive care units and was mostly performed after assessment. Maintaining joint range of motion was the main aim for performing PROM. Variability was found in the sets and repetitions of PROM administered. Various factors influenced the practice of PROM.
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Affiliation(s)
- Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Veena Raigangar
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Aishwarya Gatty
- College of Physiotherapy, Srinivas University, Mangaluru, Karnataka, India
| | - Shamma Mohammad
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Asma Alzarooni
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Marah Atef
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rawan Abdulrahman
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sara Redha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Aisha Rashid
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - May Tamim
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Bernal-Utrera C, Anarte-Lazo E, Gonzalez-Gerez JJ, De-La-Barrera-Aranda E, Saavedra-Hernandez M, Rodriguez-Blanco C. Could Physical Therapy Interventions Be Adopted in the Management of Critically Ill Patients with COVID-19? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1627. [PMID: 33567748 PMCID: PMC7915254 DOI: 10.3390/ijerph18041627] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
As part of COVID-19 consequences, it has been estimated that 5% of patients affected by this disease will require admission to the intensive care unit (ICU), and physical therapy techniques have been implemented in patients with other conditions admitted to ICU. The aim of the present study is to summarize all the available information about the implementation of physical therapy management in critically ill patients. From three clinical guidelines already published, we performed a search in PubMed, Scopus, ScienceDirect, and CINAHL, including systematic reviews, clinical guidelines, and randomized controlled trials, among others. Data extraction was performed independently by two reviewers. Quality assessment was developed through the AMSTAR-2 tool and PEDro Scale. A narrative synthesis was performed and 29 studies were included. The information extracted has been classified into four folders: ICU environment in COVID-19 (security aspects and management of the patient), respiratory physiotherapy (general indications and contraindications, spontaneously breathing and mechanically ventilated patient approaches), positional treatment, and exercise therapy (safety aspects and progression). The implementation of physiotherapy in patients affected with COVID-19 admitted to the ICU is a necessary strategy that prevents complications and contributes to the stabilization of patients in critical periods, facilitating their recovery.
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Affiliation(s)
- Carlos Bernal-Utrera
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
- Fisiosur I+D Research Institute, 04630 Almería, Spain; (J.J.G.-G.); (E.D.-L.-B.-A.); (M.S.-H.)
| | - Ernesto Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, 41009 Seville, Spain;
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Juan Jose Gonzalez-Gerez
- Fisiosur I+D Research Institute, 04630 Almería, Spain; (J.J.G.-G.); (E.D.-L.-B.-A.); (M.S.-H.)
- Department Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain
| | - Elena De-La-Barrera-Aranda
- Fisiosur I+D Research Institute, 04630 Almería, Spain; (J.J.G.-G.); (E.D.-L.-B.-A.); (M.S.-H.)
- Morphological and Socio-Health Sciences Department, University of Cordoba, 14071 Cordoba, Spain
| | - Manuel Saavedra-Hernandez
- Fisiosur I+D Research Institute, 04630 Almería, Spain; (J.J.G.-G.); (E.D.-L.-B.-A.); (M.S.-H.)
- Department Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain
| | - Cleofas Rodriguez-Blanco
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
- Fisiosur I+D Research Institute, 04630 Almería, Spain; (J.J.G.-G.); (E.D.-L.-B.-A.); (M.S.-H.)
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Organizational structures and early mobilization practices in South African public sector intensive care units-A cross-sectional study. J Eval Clin Pract 2021; 27:42-52. [PMID: 32141685 PMCID: PMC7483254 DOI: 10.1111/jep.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Understanding current early mobilization practice of patients in intensive care unit (ICU) is critical to the design and implementation of strategies to facilitate its application in a diverse population of critically ill patients encountered in public sector hospitals. AIM To evaluate the organizational structures of South African public sector hospital ICUs and to describe early mobilization practices in these units. METHODS A cross-sectional survey was done in participating public hospitals from eight provinces in South Africa. Convenience sampling was done. Data collected included hospital and ICU structure, adult patient demographic and clinical data, and mobilization activities done in ICU over the previous 24 hours prior to the day of the survey. RESULTS A total of 29 ICUs from 13 participating hospitals were surveyed resulting in 205 patient records. Majority of the surveyed ICUs were "open" type (n = 16; 55.2%). A standardized sedation scoring system was used in 18 units (62.1%) and only two units (6.9%) had an early mobilization protocol in place. Mean age of the patients surveyed was 43.5 (±17.7) years and 148 (72.2%) patients were on mechanical ventilation. Primary reasons for admission to ICU included traumatic injury (n = 86; 42%) and postoperative care (n = 33; 16.1%). Mobilization activities performed in the previous 24 hours included turning the patient in bed (n = 88; 42.9%), marching on the spot (n = 9; 4.4%) and walking (n = 10; 4.9%). Out-of-bed mobilization was done in only 40 (19.5%) patients. The most common barriers to early mobilization included patient unresponsiveness (n = 50; 24.4%) and hemodynamic instability (n = 42; 20.5%). The type of ventilation was found to have a significant positive relationship with out-of-bed patient mobilization (P = .000). CONCLUSIONS A small proportion of patients attained their highest level of mobilization in ICU. The type of ventilation influenced early mobilization practices in public sector ICUs in South Africa.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Carvalho MTX, Real AA, Cabeleira ME, Schiling E, Lopes I, Bianchin J, da Silva AMV, Annoni R, de Albuquerque IM. Acute effect of passive cycling exercise on serum levels of interleukin-8 and interleukin-10 in mechanically ventilated critically ill patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2018.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aimsA growing body of evidence has demonstrated that early mobilisation is beneficial for patients in the intensive care unit. The aim of this prospective study was to investigate the acute effect of an early passive cycling exercise session on serum interleukin-8 and interleukin-10 levels in critically ill patients.MethodsA total of 11 haemodynamically stable and deeply sedated (Richmond Agitation and Sedation Scale-4) adult patients within the first 48 hours of mechanical ventilation received a single 20-minute session of passive cycle ergometer. Serum interleukin-8 and interleukin-10 levels were measured at baseline, immediately after the intervention and 60 minutes after the intervention.FindingsInterleukin-8 levels decreased significantly 60 minutes after the passive cycle ergometer session compared to baseline (P=0.001). The serum levels of interleukin-10 increased immediately after the end of the 20 minutes and at 60 minutes after the intervention (P<0.001).ConclusionsA single 20-minute session of passive cycle ergometer seems to have a positive effect on the inflammatory response in critically ill patients.
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Affiliation(s)
| | - Amanda Albiero Real
- Functional Rehabilitation Post-Graduate Program, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Maria Eduarda Cabeleira
- School of Physiotherapy, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Emilly Schiling
- School of Physiotherapy, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Isabela Lopes
- School of Physiotherapy, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Jéssica Bianchin
- School of Physiotherapy, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Raquel Annoni
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Sandvik RK, Olsen BF, Rygh LJ, Moi AL. Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review. J Clin Nurs 2020; 29:1488-1498. [PMID: 31989720 DOI: 10.1111/jocn.15194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To describe what is known from the existing literature on nonpharmacological interventions targeting pain in patients admitted to the ICU. BACKGROUND Patients receiving intensive care nursing are exposed to a wide range of pain provoking tissue damage, diseases, surgery and other medical procedures in addition to the pain caused by nursing care procedures. The present shift to light sedation to improve patient outcomes and comfort underscores the need for effective pain management. Opioids are the mainstay for treating pain in the ICUs, whereas nonpharmacological treatments are understudied and possibly under-used. METHOD A scoping review was undertaken using five of the six steps in the Arksey and O´Malley framework: (a) identification of the research question, (b) identification of relevant studies, (c) study selection, (d) charting the data and (e) collating, summarising and reporting the results. CINAHL, MEDLINE, PubMed, BMJ Best Practice, British Nursing Index and AMED databases were searched using relevant keywords to capture extensive evidence. Data were analysed using the six-step criteria for scoping reviews suggested by Arksey and O´Malley for data extraction. To ensure quality and transparency, we enclosed the relevant Equator checklist PRISMA. RESULTS Our search yielded 10,985 articles of which 12 studies were included. Tools for pain assessments were VAS, NRS, ESAS and BPS. Interventions explored were hypnosis, simple massage, distraction, relaxation, spiritual care, harp music, music therapy, listening to natural sounds, passive exercise, acupuncture, ice packs and emotional support. Reduction in pain intensity was conferred for hypnosis, acupuncture and natural sounds. CONCLUSION The findings support further investigations of acupuncture, hypnosis and listening to natural sounds. RELEVANCE TO CLINICAL PRACTICE The main finding suggests the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity, pain proportion and the impact on opioid consumption and sedation requirements.
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Affiliation(s)
- Reidun K Sandvik
- Departement of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Brita F Olsen
- Intensive and Post-operative Unit, Østfold Hospital Trust, Sarpsborg, Norway
- Faculty of Health and Welfare, Østfold University College, Fredrikstad, Norway
| | - Lars-Jørgen Rygh
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Asgjerd Litlere Moi
- Departement of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
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França EET, Gomes JPV, De Lira JMB, Amaral TCN, Vilaça AF, Paiva Júnior MDS, Elihimas Júnior UF, Correia Júnior MAV, Forgiarini Júnior LA, Costa MJC, Andrade MA, Ribeiro LC, De Castro CMMB. Acute effect of passive cycle-ergometry and functional electrical stimulation on nitrosative stress and inflammatory cytokines in mechanically ventilated critically ill patients: a randomized controlled trial. ACTA ACUST UNITED AC 2020; 53:e8770. [PMID: 32294698 PMCID: PMC7162584 DOI: 10.1590/1414-431x20208770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.
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Affiliation(s)
- E E T França
- Departamento de Fisioterapia e Programa de Pós-graduação em Fisioterapia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - J P V Gomes
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - J M B De Lira
- Programa de Residência de Clínica Médica, Hospital Otávio de Freitas, Recife, PE, Brasil
| | - T C N Amaral
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - A F Vilaça
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - M D S Paiva Júnior
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - U F Elihimas Júnior
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - M A V Correia Júnior
- Programa de Pós-graduação em Educação Física e Hebiatria, Universidade de Pernambuco, Recife, PE, Brasil
| | - L A Forgiarini Júnior
- Departamento de Fisioterapia e Programa de Pós-graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
| | - M J C Costa
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - M A Andrade
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - L C Ribeiro
- Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
| | - C M M B De Castro
- Departamento de Fisioterapia e Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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11
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Fisser C, Spoletini G, Soe AK, Livesey A, Schreiber A, Swingwood E, Bos LD, Dreher M, Schultz MJ, Heunks L, Scala R. European Respiratory Society International Congress 2018: highlights from Assembly 2 on respiratory intensive care. ERJ Open Res 2019; 5:00198-2018. [PMID: 30847349 PMCID: PMC6397914 DOI: 10.1183/23120541.00198-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions held at the International Congress in Paris in 2018. For the highly esteemed reader who may have missed the Congress, a concise review was written on three topics: the state-of-the-art session on respiratory critical care, hot topics in weaning and the best abstracts in noninvasive ventilation. The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions from the 2018 #ERSCongress in Parishttp://ow.ly/6Du830nFESK
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Affiliation(s)
- Christoph Fisser
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Dept of Pneumology, Hospital Donaustauf, Donaustauf, Germany
| | - Giulia Spoletini
- Respiratory Dept, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Aung Kyaw Soe
- Dept of Hospital Therapy, Pediatric Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alana Livesey
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Annia Schreiber
- Dept of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
| | - Ema Swingwood
- Physiotherapy Dept - Adult Therapy Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lieuwe D Bos
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Michael Dreher
- Dept of Pneumology and Intensive Care Medicine, University Hospital Aachen, Germany
| | - Marcus J Schultz
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Leo Heunks
- Dept of Intensive Care, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
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12
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Santos LMH, Novaes APLD, Dantas FMDNA, Ribeiro LC, Castro CMMBD, França EETD. Acute effect of passive cycloergometry on the cardiovascular system and respiratory mechanics of critically ill patients: a randomized controlled trial. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The rehabilitation of critical patients usually occurs in the bed and is classified as low cardiovascular intensity. Therefore, it is essential to understand the physiological effects of these resources that we apply in clinical practice. Objective: Evaluate the acute effect of passive cycloergometry of lower limbs on respiratory mechanics and cardiovascular parameters in critically ill patients. Method: This was a labeled, randomized, controlled trial conducted in two intensive care units in the city of Recife, between August 2016 and May 2017. Patients were divided into two groups: (i) passive cycloergometry group (n = 16), where the patient performed a lower limb cycloergometry session for 20 minutes, and (ii) control group (n = 14), where the patient did not perform any therapeutic intervention, except during the application of the protocol. Cardiovascular parameters and respiratory mechanics were evaluated before, during and after their applicability. Results: No demographic differences were found between the two groups, showing the homogeneity between them. Regarding cardiovascular parameters, there were no differences between groups before, during and after the protocol. Regarding respiratory mechanics, there was a slight elevation of the resistance of the respiratory system in the cycloergometry group and a reduction of the same in the control group. Conclusion: The results suggest that passive cycloergometry applied to the critical patient did not promote significant cardiovascular changes and respiratory mechanics, being considered a safe and effective technique in clinical practice that can be applied without causing harm to patients under mechanical ventilation.
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13
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Newman ANL, Gravesande J, Rotella S, Wu SS, Topp-Nguyen N, Kho ME, Harris JE, Fox-Robichaud A, Solomon P. 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: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Affiliation(s)
- Anastasia N L Newman
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada; Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
| | - Janelle Gravesande
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
| | - Stephanie Rotella
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada
| | - Stephen S Wu
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada
| | - Nam Topp-Nguyen
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada.
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada; Physiotherapy Department, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
| | - Alison Fox-Robichaud
- Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, Division of Critical Care, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada.
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14
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Conceição TMAD, Gonzáles AI, Figueiredo FCXSD, Vieira DSR, Bündchen DC. Safety criteria to start early mobilization in intensive care units. Systematic review. Rev Bras Ter Intensiva 2018; 29:509-519. [PMID: 29340541 PMCID: PMC5764564 DOI: 10.5935/0103-507x.20170076] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/24/2017] [Indexed: 01/26/2023] Open
Abstract
Mobilization of critically ill patients admitted to intensive care units should
be performed based on safety criteria. The aim of the present review was to
establish which safety criteria are most often used to start early mobilization
for patients under mechanical ventilation admitted to intensive care units.
Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL
databases; randomized and quasi-randomized clinical trials, cohort studies,
comparative studies with or without simultaneous controls, case series with 10
or more consecutive cases and descriptive studies were included. The same was
performed regarding prospective, retrospective or cross-sectional studies where
safety criteria to start early mobilization should be described in the Methods
section. Two reviewers independently selected potentially eligible studies
according to the established inclusion criteria, extracted data and assessed the
studies' methodological quality. Narrative description was employed in data
analysis to summarize the characteristics and results of the included studies;
safety criteria were categorized as follows: cardiovascular, respiratory,
neurological, orthopedic and other. A total of 37 articles were considered
eligible. Cardiovascular safety criteria exhibited the largest number of
variables. However, respiratory safety criteria exhibited higher concordance
among studies. There was greater divergence among the authors regarding
neurological criteria. There is a need to reinforce the recognition of the
safety criteria used to start early mobilization for critically ill patients;
the parameters and variables found might contribute to inclusion into service
routines so as to start, make progress and guide clinical practice.
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Affiliation(s)
| | - Ana Inês Gonzáles
- Departamento de Fisioterapia, Universidade Federal de Santa Catarina - Araranguá, (SC), Brasil
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15
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Noll DR. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review. J Osteopath Med 2017; 116:600-8. [PMID: 27571297 DOI: 10.7556/jaoa.2016.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The contemporary management of infectious diseases is built around antimicrobial therapy. However, the development of antimicrobial resistance threatens to create a post-antibiotic era. Antimicrobial stewardship attempts to reduce the development of antimicrobial resistance by improving their appropriate use. Osteopathic manipulative treatment as an adjunctive treatment has the potential for enhancing antimicrobial stewardship by enhancing the human immune system, shortening the duration of antimicrobial therapy, reducing complications, and improving treatment outcomes. The present article reviews the evidence published in the literature since this unique treatment approach was first developed more than 100 years ago. The evidence suggests that adjunctive osteopathic manipulative treatment has great potential for enhancing antimicrobial stewardship and should be further investigated.
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16
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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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17
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Sommers J, Engelbert RHH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, van der Schaaf M. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015; 29:1051-63. [PMID: 25681407 PMCID: PMC4607892 DOI: 10.1177/0269215514567156] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/14/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. METHODS We used the EBRO method, as recommended by the 'Dutch Evidence Based Guideline Development Platform' to develop an 'evidence statement for physiotherapy in the intensive care unit'. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. RESULTS Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. CONCLUSIONS These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014.
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Affiliation(s)
- Juultje Sommers
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands Education of Physiotherapy, University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Rik Gosselink
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Peter E Spronk
- Department of Intensive Care, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands
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18
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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; 30:664-672. [PMID: 25987293 DOI: 10.1016/j.jcrc.2015.03.032] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [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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19
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Ntoumenopoulos G. Rehabilitation during mechanical ventilation: Review of the recent literature. Intensive Crit Care Nurs 2015; 31:125-32. [PMID: 26026495 DOI: 10.1016/j.iccn.2015.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 01/27/2023]
Abstract
Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive care unit acquired weakness, delirium and a loss of physical function that may persist well beyond ICU and hospital discharge. Factors such as the requirement for intubation and mechanical ventilation, sedation, systemic inflammation and immobility are associated with the development of these physical and psychological complications. Implementation of rehabilitation in mechanically ventilated patients has been demonstrated to be both safe and feasible and provide benefits in terms of physical and psychological function and assist with weaning from mechanical ventilation. The recent relevant literature on the role of rehabilitation interventions in the mechanically ventilated patient will be discussed.
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Affiliation(s)
- George Ntoumenopoulos
- School of Physiotherapy, Australian Catholic University, Sydney, Australia; Physiotherapy Department, St. Vincents Hospital, Sydney, Australia; Physiotherapy Department, Guy's and St. Thomas' NHS Foundation Trust, Kings Health Partners, London, United Kingdom.
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20
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Blot S, Afonso E, Labeau S. Insights and advances in multidisciplinary critical care: a review of recent research. Am J Crit Care 2014; 23:70-80. [PMID: 24382619 DOI: 10.4037/ajcc2014403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The intensive care unit is a work environment where superior dedication is pivotal to optimize patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the abundance of research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovations in the field. This article broadly summarizes new developments in multidisciplinary intensive care, providing elementary information about advanced insights in the field by briefly describing selected articles bundled in specific topics. Issues considered include cardiovascular care, monitoring, mechanical ventilation, infection and sepsis, nutrition, education, patient safety, pain assessment and control, delirium, mental health, ethics, and outcomes research.
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Affiliation(s)
- Stijn Blot
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Elsa Afonso
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Sonia Labeau
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium. Elsa Afonso is a research nurse and clinical trial coordinator, CIBERES, Barcelona, Spain. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
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