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

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 (Po0.001) and FES (Po0.05), 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.

Passive motion of the lower extremities in sedated and ventilated patients in the ICU – a systematic review of early effects and replicability of Interventions

“…The total of 87 patients (19 women and 49 men, 19 patients’ sex unclear) were on average 56.4 years old. The number of days with ventilation before the start of the study was only stated in two studies and ranged from a median of 4 days [ 24 ] to 6.44 ± 0.333 days in the intervention group and 4.9 ± 2.80 days in the control group [ 42 ]. All patients in the included studies were deeply sedated (RASS -4 or -5, Ramsay score 6), comatose or relaxed.…”

“…All patients in the included studies were deeply sedated (RASS -4 or -5, Ramsay score 6), comatose or relaxed. Severity of the disease was stated in three studies with the APACHE II score and showed in average 18.6 points and, with 24%, therefore a low average risk of dying in hospital [ 26 , 42 , 43 ]. In another study the SAPS II score was used and a value of 57.5 ± 24 suggests a 50–75% in-hospital mortality [ 24 ].…”

Instrumentos de avaliação para o diagnóstico da fraqueza muscular adquirida na unidade de terapia intensiva: Revisão narrativa

“…Com isso, vem se destacando a mobilização precoce para reduzir a fraqueza muscular, na qual os exercícios se iniciam cada vez mais cedo. Atualmente existem diretrizes de exercícios para doentes críticos que são fundamentadas em níveis de mobilidade, que diversificam do exercício passivo a caminhada (França, Gomes, De Lira, Amaral, Vilaça & Paiva Júnior et al, 2020).…”

“…O estudo de França et al (2020) pacientes críticos como técnica para pacientes que ainda não são capazes de cooperar devido a sedação, os resultados apontaram que a vibração induz a ativação muscular, podendo prevenir a FMA na UTI, e se mostrou segura por não causar alterações hemodinâmicas significativas. Na pesquisa de Sarfati, Moore, Pilorge, Amaru, Mendialdua e Rodet et al (2018) a inclinação passiva foi usada após cirurgia cardiotorácica em pacientes de UTI, os resultados não demonstraram melhora da força muscular após o uso da técnica, porém sugeriram uma recuperação mais rápida.…”

“…A FMA ocorre em pacientes em repouso prolongado e está relacionada a alterações do metabolismo celular decorrente da falta de exercício. A contração muscular ativa é importante no manejo e controle de complicações inerentes em pacientes críticos, Enciso-Olivera, Galvis-Rincón, Torre-Díaz, Devia-León e Camargo-Puerto (2016) embasados no princípio da sobrecarga, utilizaram um protocolo de carga progressiva, objetivando avaliar se as alterações cardiovasculares relacionadas ao exercício limitavam ou impediam a realização de exercício ativo em pacientes críticos, corroborando com o estudo de França et al (2020), verificaram que a estabilidade nas variáveis de pressão arterial e frequência cardíaca, permitem estabelecer de forma segura o exercício ativo com cargas controladas e monitoradas de forma progressiva. Sendo assim a mobilização precoce vem se tornando rotineira em UTI por se mostrar uma técnica segura e eficaz para prevenir a FMA.…”