Physical Therapy Management of Two Patients with Stage D Heart Failure in the Cardiac Medical Intensive Care Unit

Macauley, Kelly

doi:10.1097/01823246-201223030-00006

Cited by 9 publications

(7 citation statements)

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“…For HF inpatients, a case report used a progressive, semi-independent interval-walking program in a patient with advanced HF on continuous dobutamine therapy showed functional improvements and the clinical utility of the 6MWT [26] . Similar results were reported in another case report that used ambulation sessions and seated lower extremity ergometer sessions [27] . Moreover, Arena et al [8] demonstrated in a case report that exercise training consisting of ambulation on a treadmill, lower extremity ergometer, and resistive exercises improved aerobic exercise time and sustainable exercise workload in an inpatient awaiting heart transplantation while on intravenous positive inotropic support.…”

Section: Discussionsupporting

confidence: 89%

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot

Forestieri¹,

Guizilini²,

Peres³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveThe purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support.MethodsPatients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols.ResultsBoth groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P=0.08 and P=0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P<0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P=0.22 and P<0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P<0.01).ConclusionStationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.

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Section: Discussionsupporting

confidence: 89%

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot

Forestieri¹,

Guizilini²,

Peres³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…A small amount of literature exists that indicates that patients on continuous inotropic support can tolerate exercise in the inpatient intensive care [11], general medical inpatient [12], and outpatient [13,14] settings. We report the first 3 cases of patients on continuous inotropic support who underwent acute inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

An Appropriate Population for Acute Inpatient Rehabilitation? A Case Series of Three Patients With Advanced Heart Failure on Continuous Inotropic Support

McCormick

Chu

Goodman

et al. 2015

PM&R

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The number of individuals with heart failure and the treatment modalities available to manage heart failure are increasing. Continuous inotropic support is a treatment modality used in cases of severe heart failure. Although most patients initiated on continuous inotropic support are discharged home, those with greater functional compromise, comorbid conditions that cause disability, or other significant medical complexity may be referred to acute inpatient rehabilitation. The feasibility and benefits of acute inpatient rehabilitation in this population, however, has yet to be investigated. We report the functional progress and medical complications of 3 patients on continuous inotropic support who participated in acute inpatient rehabilitation. The patients demonstrated varying levels of success, highlighting a need for evidence-based, preadmission screening criteria for this population.

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“…Physical therapy (PT) expertise can provide needed advice on the head‐of‐bed elevation, lower extremity strengthening, and participation in functional activities. A prior case report on the feasibility of a tilt table program and increased time of weight‐bearing activity in the upright position for patients on femoral IABP has been described 12 …”

Section: Introductionmentioning

confidence: 99%

“…A prior case report on the feasibility of a tilt table program and increased time of weight-bearing activity in the upright position for patients on femoral IABP has been described. 12 Based on this data, a multidisciplinary team at a large, urban transplant center has developed and implemented a structured tilting PT protocol that focuses on increasing the activity of patients who are on IABP support (Figure 1). We hypothesized that patients who received the structured tilting PT protocol would have a decreased length of stay after transplantation and fewer adverse events when compared to those that received standard PT therapy.…”

Section: Introductionmentioning

confidence: 99%

Impact of structured physical therapy protocol among heart transplant recipients while on intra‐aortic balloon pump in the pretransplant period

et al. 2022

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Background Use of prolonged femoral intra‐aortic balloon pump support limits the mobility of patients awaiting heart transplant. We assessed the safety and outcomes of a structured, tilting physical therapy protocol in patients supported by intra‐aortic balloon pumps while awaiting transplant. Methods We retrospectively reviewed five years of transplant patients. Eighteen patients received femoral intra‐aortic balloon support, a heart transplant, and met all eligibility criteria. We compared complications and outcomes between patients who received the structured, tilting physical therapy (Protocol Group) and those that received standard of care (Control Group). Results Complications were not significantly different between groups. The majority of the Protocol Group were discharged to home (10/12), while half (3/6) of the Control Group were discharged to a rehabilitation facility. Post‐transplant length of stay was significantly less in the Protocol Group (median 16 vs. 28 days, p = 0.03). Conclusion Despite the small number analyzed, the data indicates that the structured, tilting physical therapy protocol led to a significantly reduced length of stay post‐transplantation. Importantly, use of the protocol did not result in access site complications, thrombosis, or arrhythmias in the majority of the patients.

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Physical Therapy Management of Two Patients with Stage D Heart Failure in the Cardiac Medical Intensive Care Unit

Cited by 9 publications

References 0 publications

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot

A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot

An Appropriate Population for Acute Inpatient Rehabilitation? A Case Series of Three Patients With Advanced Heart Failure on Continuous Inotropic Support

Impact of structured physical therapy protocol among heart transplant recipients while on intra‐aortic balloon pump in the pretransplant period

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