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

Abstract

BackgroundIn 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.MethodsA 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.ResultsThe 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.ConclusionMost 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 registrationClinicalTrials.gov, NCT02920684. Registered on 30 September 2016.Prospectively registered.

Neuromuscular electrical stimulation in early rehabilitation of patients with postoperative complications after cardiovascular surgery

“…The training impact of isolated NMES is inferior to active training with voluntary muscle contractions, [ 13 ] therefore, it is usually proposed to combine NMES with active exercises, [ 14 ] for example, such a combination is used in athletes. [ 15 ] This is not surprising, since NMES provides an additional activation of those muscle fibers that are not involved in the voluntary muscle contraction.…”

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

“…According to these levels of mobility, both passive cycle-ergometry (PCE) and functional electrical stimulation (FES) application provide muscle contraction without increasing cardiovascular work, thus allowing patients with severe ventilatory insufficiency to tolerate this type of peripheral muscle training (6).…”

“…To our knowledge, muscle and cardiovascular responses to different forms of bed exercise have never been compared. The most commonly used types of bed exercise are PCE and quadriceps electrical stimulation (6). However, their effects on immune response parameters and nitrosative stress in these patients remain unclear.…”

Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review

“…There was a trend toward faster recovery of functional milestones, reduced delirium, and reduced need for rehabilitation posthospital discharge . Medrinal et al explored the impact of 4 different assistive rehabilitation strategies (passive range of motion exercises with therapist, NMES, cycle ergometry, and FES) on cardiorespiratory response to exercise. The study demonstrated that FES cycling was the main intervention, which increased cardiac output and produced sufficient intensity of muscle work; however, a recent study that combined NMES and cycling reported no difference in outcomes in terms of muscle strength and ventilator‐free days or HRQoL at 6 months …”