Caloric consumption during early mobilisation of mechanically ventilated patients in Intensive Care Units

Nydahl, Peter; Schuchhardt, Danny; Jüttner, F.; Dubb, Rolf; Hermes, Carsten; Kaltwasser, Arnold; Mende, Hendrik; Müller-Wolff, Tilmann; Rothaug, Oliver; Schreiber, Torsten

doi:10.1016/j.clnu.2019.10.028

Cited by 10 publications

(6 citation statements)

References 33 publications

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“…Additionally, it allowed us to specifically analyse explanatory variables and their estimated effect. In this regard, our results support previous research that active exercises and out-of-bed mobilisations lead to stronger physiological reactions than passive exercises or in-bed mobilisations [ 11 , 14 – 17 , 34 , 35 ]. Nevertheless, the cardiorespiratory response to ‘session duration’, ‘session type’ and ‘mobilisation level’ does not seem as straightforward due to considerable overlap ( S2 File : S3 Table).…”

Section: Discussionsupporting

confidence: 91%

Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial

et al. 2022

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Introduction Early rehabilitation is indicated in critically ill adults to counter functional complications. However, the physiological response to rehabilitation is poorly understood. This study aimed to determine the cardiorespiratory response to rehabilitation and to investigate the effect of explanatory variables on physiological changes during rehabilitation and recovery. Methods In a prospectively planned, secondary analysis of a randomised controlled trial conducted in a tertiary, mixed intensive care unit (ICU), we analysed the 716 physiotherapy-led, pragmatic rehabilitation sessions (including exercise, cycling and mobilisation). Participants were previously functionally independent, mechanically ventilated, critically ill adults (n = 108). Physiological data (2-minute medians) were collected with standard ICU monitoring and indirect calorimetry, and their medians calculated for baseline (30min before), training (during physiotherapy) and recovery (15min after). We visualised physiological trajectories and investigated explanatory variables on their estimated effect with mixed-effects models. Results This study found a large range of variation within and across participants’ sessions with clinically relevant variations (>10%) occurring in more than 1 out of 4 sessions in mean arterial pressure, minute ventilation (MV) and oxygen consumption (VO2), although early rehabilitation did not generally affect physiological values from baseline to training or recovery. Active patient participation increased MV (mean difference 0.7l/min [0.4–1.0, p<0.001]) and VO2 (23ml/min [95%CI: 13–34, p<0.001]) during training when compared to passive participation. Similarly, session type ‘mobilisation’ increased heart rate (6.6bpm [2.1–11.2, p = 0.006]) during recovery when compared to ‘exercise’. Other modifiable explanatory variables included session duration, mobilisation level and daily medication, while non-modifiable variables were age, gender, body mass index and the daily Sequential Organ Failure Assessment. Conclusions A large range of variation during rehabilitation and recovery mirrors the heterogenous interventions and patient reactions. This warrants close monitoring and individual tailoring, whereby the best option to stimulate a cardiorespiratory response seems to be active patient participation, shorter session durations and mobilisation. Trial registration German Clinical Trials Register (DRKS) identification number: DRKS00004347, registered on 10 September 2012.

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Section: Discussionsupporting

confidence: 91%

Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial

et al. 2022

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“…Highly invasive cases and nutritional disorders are more severe because of hyperglycemia and accelerated muscle breakdown (37) . However, the energy expenditure associated with leaving the bed is negligible (38) , and leaving the bed should be actively practiced to prevent disuse syndrome. As metabolism shifts to anabolism, skeletal muscle mass is expected to increase, and active nutritional management and physical therapy should be performed to improve nutritional status and physical function.…”

Section: The Effect Of Physical Therapy On Nutritionmentioning

confidence: 99%

Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication)

Inoue

Iida

Takahashi³

et al. 2022

JMA J

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Several patients undergoing physical therapy have nutritional problems. Knowledge of nutrition is necessary for addressing nutritional problems, such as malnutrition, sarcopenia, frailty, and cachexia. However, the relationship between physical therapy and nutrition is not fully understood. Physical therapy plays an important role in nutritional management, and evaluations, such as muscle strength and muscle mass evaluations, play an important role in nutritional screening and diagnosis. Exercise, as the core of physical therapy, is essential for nutritional interventions. Several recent studies have suggested that a combination of nutrition and physical therapy interventions can maximize the function, activity, participation, and quality of life of patients. The combination of nutrition and physical therapy interventions is key to addressing the needs of modern and diverse populations. This position paper was developed by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition in consultation with the Japanese Society of Nutrition and Swallowing Physical Therapy.

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“…Delayed initiation of nutrition support has been found in 60% of cases. In addition, an incorrect EN regimen can lead to under- or overfeeding, which, together with the inflammatory response typical for this metabolic state, can contribute to hyperglycaemia, loss of muscle mass and strength, prolonged rehabilitation, as well as an increase in comorbidities resulting in deteriorated quality of life in the long term [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies suggest that diet-only interventions are insufficient to improve patients’ nutritional status and reduce comorbidities, and this is now reflected in current recommendations [ 2 ]. To mitigate this deterioration, early mobilization in the ICU is recommended [ 5 ]. The combination of nutrition plus exercise may modify the catabolic effects of critical illness, muscle wasting, and the development of ICUAW, which has been identified as a research priority [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Enteral nutrition management in critically ill adult patients and its relationship with intensive care unit-acquired muscle weakness: A national cohort study

et al. 2023

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Objective To assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours. Methods A prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3–7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN. Results 319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; p<0.001). Protein intake was deficient (as per US/European guidelines) during ICU days 3–7. Conclusions The incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset. Relevance to clinical practice Low mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.

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Caloric consumption during early mobilisation of mechanically ventilated patients in Intensive Care Units

Cited by 10 publications

References 33 publications

Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial

Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial

Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication)

Enteral nutrition management in critically ill adult patients and its relationship with intensive care unit-acquired muscle weakness: A national cohort study

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