Research Article
BibTex RIS Cite

SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS

Year 2020, Volume: 31 Issue: 2, 123 - 132, 28.08.2020
https://doi.org/10.21653/tjpr.664967

Abstract

Purpose: Patients in intensive care units (ICU) are often exposed to prolonged immobilization, which, in turn, plays a vital role in impaired functional status. Exercise with an arm cycle ergometer (ACE) could be a treatment option to minimize the harmful effects of immobility. This study was aimed to investigate whether using ACE is a safe and effective intervention for preventing or attenuating the decrease in functional status in critically ill patients. Methods: A total of 35 adult critically ill patients were recruited for this study from among those admitted to the ICU. The subjects received conventional physiotherapy or conventional physiotherapy with an additional ACE intervention during their stay in the ICU. The intervention was administered passively or actively based on clinical status for 20 minutes, once a day, five days a week. During the ACE training, cardiopulmonary responses and the highest/lowest values were recorded before, during, and immediately and 5 minutes after the exercise. Cardiopulmonary responses recorded at the first, the second, and discharge days of the training (last training session) were analyzed. Ambulation Score and Barthel Index were used to evaluate the functional level. Results: Although cardiopulmonary responses were varied with ACE exercise (p<0.05), these changes stayed within the safety limits. At ICU discharge, there were no significant differences between the groups regarding functional level scores (p>0.05). Conclusion: In the ICU, the daily exercise of ACE training is possible and safe. Further study is needed to determine the effects of exercise training using ACE on the functional outcomes.

References

  • 1. Yosef-Brauner O, Adi N, Ben Shahar T, Yehezkel E, Carmeli E. Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. The Clinical Respiratory Journal. 2015;9(1):1-6.
  • 2. Saxena M, Hodgson CL. Intensive care unit acquired weakness. Anaesthesia and Intensive Care Medicine. 2012;13:145-7.
  • 3. Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. The American Journal of the Medical Sciences. 2011;341:373-7.
  • 4. Needham DM. Mobilizing patients in intensive car unit: improving neuromuscular weakness and physical function. JAMA. 2008;300:1685-90.
  • 5. de Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquaired weakness, risk factors and prevention. Critical Care Medicine. 2009;37(10):309-15.
  • 6. Truong AD, Fan E, Brower RG, Dale M. Bench-to-bed side review: mobilizing patients in the intensive care unit-from pathophysiology to critical trials. Critical Care. 2009;13(4):216.
  • 7. Nordon-Craft A, Moss M, Quan D, Schenckman M. Intensive care acquired weakness. Journal of Neurologic Physical Therapy. 2011;35(133-140).
  • 8. Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Critical Care Medicine. 2010;38(11):2089-94.
  • 9. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.
  • 10. Clini E, Ambrosino N. Early physiotherapy in the respiratory intensive care unit. Respiratory Medicine. 2005;99(9):1096-104.
  • 11. Hough A. Physiotherapy in respiratory and cardiac care: an evidence-based approach. 4th ed. Hampshire: Cangage Learning EMEA; 2014.
  • 12. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short-term functional recovery. Critical Care Medicine. 2009 Sep;37(9):2499-505.
  • 13. Porta R, Vitacca M, Gile LS, Clini E, Bianchi L, Zanotti E, et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest. 2005;128:2511-20.
  • 14. Vitacca M, Bianchi L, Sarvà M, Paneroni M, Balbi B. Physiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease. Intensive Care Medicine. 2006;32(8):1159-66.
  • 15. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Archives of Physical Medicine and Rehabilitation. 2010;91(4):536-42.
  • 16. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine. 1985;13:818-29.
  • 17. Vincent JL, Moreno R, Takala J. The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine. 1996;22:707-10.
  • 18. Menzies R, Gibbons W, Goldberg P. Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest. 1989;95(2):398-405.
  • 19. Paul DB, Umamaheswara Rao GS. Correlation of bıspectral ındexwıth glasgow coma score ın mıld and moderate head injuries. Journal of Clinical Monitoring and Computing. 2006;20(6):399-404.
  • 20. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139-45.
  • 21. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scandinavian Journal of Rehabilitation Medicine. 2000;32(2):87-92.
  • 22. Camargo Pires-Neto , Perira AL, Parente C, de Sant'Anna GN, Daguer Esposio D, Kimura A, et al. Caracterization of the use of a cycle ergometer to assist in the physical therapy treatment of critically ill patients. Revista Brasileira de Terapia Intensiva. 2013;25(1):39-43.

YOĞUN BAKIMDA KOL BİSİKLET ERGOMETRESİNİN GÜVENLİ VE ETKİN KULLANIMI

Year 2020, Volume: 31 Issue: 2, 123 - 132, 28.08.2020
https://doi.org/10.21653/tjpr.664967

Abstract

Amaç: Yoğun bakım ünitelerindeki (YBÜ) hastalar genellikle uzun süreli immobilizasyona maruz kalırlar ve bu da fonksiyonel durumun kötüleşmesinde önemli bir rol oynar. Kol bisiklet ergometresi (KBE) ile egzersiz, immobilizasyonun zararlı etkilerini en aza indirmek için kullanılabilecek bir tedavi seçeneği olabilir. Bu çalışmanın amacı, kritik hastalarda KBE kullanımının fonksiyonel durumdaki azalmayı önlemeye veya azaltmaya yönelik güvenli ve etkili bir müdahale olup olmadığını araştırmaktı. Yöntem: YBÜ’ye kabul edilenler arasından stabil, kritik hastalığı olan 35 erişkin hasta bu çalışmaya alındı. Bu hastalara, YBÜ’de kaldıkları süre boyunca konvansiyonel fizyoterapi veya konvansiyonel fizyoterapiye ek olarak KBE eğitimi uygulandı. Eğitim, klinik durumlarına göre haftada 5 gün, günde bir kez 20 dakika boyunca pasif veya aktif olarak uygulandı. KBE eğitiminde, egzersiz öncesi, egzersiz sırasında, hemen sonrasında ve 5 dakika sonrasında kardiyopulmoner yanıtlar ve en yüksek/düşük değerler kaydedildi. Eğitimin birinci ve ikinci günü ile taburculukta (son eğitim seansı) kaydedilen kardiyopulmoner yanıtlar istatistiksel olarak analiz edildi. Fonksiyonel düzeyi değerlendirmek için Ambulasyon Skoru ve Barthel İndeksi kullanıldı. Sonuçlar: Kardiyopulmoner yanıtlar KBE ile değişmekle birlikte (p<0,05), bu değişiklik güvenli sınırlar içinde kaldı. YBÜ’den taburculukta fonksiyonel düzey skorları açısından gruplar arasında anlamlı fark yoktu (p>0,05). Tartışma: YBÜ’de, günlük KBE egzersizinin yapılması mümkün ve güvenlidir. KBE eğitiminin fonksiyonel sonuçlar üzerindeki etkilerini belirlemek için daha fazla çalışmaya ihtiyaç vardır.

References

  • 1. Yosef-Brauner O, Adi N, Ben Shahar T, Yehezkel E, Carmeli E. Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. The Clinical Respiratory Journal. 2015;9(1):1-6.
  • 2. Saxena M, Hodgson CL. Intensive care unit acquired weakness. Anaesthesia and Intensive Care Medicine. 2012;13:145-7.
  • 3. Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. The American Journal of the Medical Sciences. 2011;341:373-7.
  • 4. Needham DM. Mobilizing patients in intensive car unit: improving neuromuscular weakness and physical function. JAMA. 2008;300:1685-90.
  • 5. de Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquaired weakness, risk factors and prevention. Critical Care Medicine. 2009;37(10):309-15.
  • 6. Truong AD, Fan E, Brower RG, Dale M. Bench-to-bed side review: mobilizing patients in the intensive care unit-from pathophysiology to critical trials. Critical Care. 2009;13(4):216.
  • 7. Nordon-Craft A, Moss M, Quan D, Schenckman M. Intensive care acquired weakness. Journal of Neurologic Physical Therapy. 2011;35(133-140).
  • 8. Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Critical Care Medicine. 2010;38(11):2089-94.
  • 9. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.
  • 10. Clini E, Ambrosino N. Early physiotherapy in the respiratory intensive care unit. Respiratory Medicine. 2005;99(9):1096-104.
  • 11. Hough A. Physiotherapy in respiratory and cardiac care: an evidence-based approach. 4th ed. Hampshire: Cangage Learning EMEA; 2014.
  • 12. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short-term functional recovery. Critical Care Medicine. 2009 Sep;37(9):2499-505.
  • 13. Porta R, Vitacca M, Gile LS, Clini E, Bianchi L, Zanotti E, et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest. 2005;128:2511-20.
  • 14. Vitacca M, Bianchi L, Sarvà M, Paneroni M, Balbi B. Physiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease. Intensive Care Medicine. 2006;32(8):1159-66.
  • 15. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Archives of Physical Medicine and Rehabilitation. 2010;91(4):536-42.
  • 16. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine. 1985;13:818-29.
  • 17. Vincent JL, Moreno R, Takala J. The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine. 1996;22:707-10.
  • 18. Menzies R, Gibbons W, Goldberg P. Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest. 1989;95(2):398-405.
  • 19. Paul DB, Umamaheswara Rao GS. Correlation of bıspectral ındexwıth glasgow coma score ın mıld and moderate head injuries. Journal of Clinical Monitoring and Computing. 2006;20(6):399-404.
  • 20. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139-45.
  • 21. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scandinavian Journal of Rehabilitation Medicine. 2000;32(2):87-92.
  • 22. Camargo Pires-Neto , Perira AL, Parente C, de Sant'Anna GN, Daguer Esposio D, Kimura A, et al. Caracterization of the use of a cycle ergometer to assist in the physical therapy treatment of critically ill patients. Revista Brasileira de Terapia Intensiva. 2013;25(1):39-43.
There are 22 citations in total.

Details

Primary Language English
Subjects Rehabilitation
Journal Section Araştırma Makaleleri
Authors

Sinem Ayyıldız Çinar 0000-0002-2064-2284

Arzu Topeli 0000-0002-5874-9087

Mutlu Umaroğlu 0000-0002-4122-6431

Deniz İnal İnce 0000-0002-8151-0664

Sevil Bilgin 0000-0003-1597-1312

Publication Date August 28, 2020
Published in Issue Year 2020 Volume: 31 Issue: 2

Cite

APA Ayyıldız Çinar, S., Topeli, A., Umaroğlu, M., İnal İnce, D., et al. (2020). SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 31(2), 123-132. https://doi.org/10.21653/tjpr.664967
AMA Ayyıldız Çinar S, Topeli A, Umaroğlu M, İnal İnce D, Bilgin S. SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS. Turk J Physiother Rehabil. August 2020;31(2):123-132. doi:10.21653/tjpr.664967
Chicago Ayyıldız Çinar, Sinem, Arzu Topeli, Mutlu Umaroğlu, Deniz İnal İnce, and Sevil Bilgin. “SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 31, no. 2 (August 2020): 123-32. https://doi.org/10.21653/tjpr.664967.
EndNote Ayyıldız Çinar S, Topeli A, Umaroğlu M, İnal İnce D, Bilgin S (August 1, 2020) SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS. Türk Fizyoterapi ve Rehabilitasyon Dergisi 31 2 123–132.
IEEE S. Ayyıldız Çinar, A. Topeli, M. Umaroğlu, D. İnal İnce, and S. Bilgin, “SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS”, Turk J Physiother Rehabil, vol. 31, no. 2, pp. 123–132, 2020, doi: 10.21653/tjpr.664967.
ISNAD Ayyıldız Çinar, Sinem et al. “SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 31/2 (August 2020), 123-132. https://doi.org/10.21653/tjpr.664967.
JAMA Ayyıldız Çinar S, Topeli A, Umaroğlu M, İnal İnce D, Bilgin S. SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS. Turk J Physiother Rehabil. 2020;31:123–132.
MLA Ayyıldız Çinar, Sinem et al. “SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, vol. 31, no. 2, 2020, pp. 123-32, doi:10.21653/tjpr.664967.
Vancouver Ayyıldız Çinar S, Topeli A, Umaroğlu M, İnal İnce D, Bilgin S. SAFE AND EFFECTIVE USE OF ARM CYCLE ERGOMETRY IN CRITICALLY ILL PATIENTS. Turk J Physiother Rehabil. 2020;31(2):123-32.