Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects.
BACKGROUND: Early mobilization during critical illness is safe and has beneficial effects on functional outcomes. However, its impact on pulmonary function has not been thoroughly explored. We hypothesized that a sitting position out of bed coupled with exercise could result in an improvement in oxy...
| Published in: | Respiratory Care Vol. 66; no. 2; pp. 253 - 263 |
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| Main Authors: | , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Feb2021
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=148679316&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 148679316 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2021 vid: 66 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 148679316 148679316 148679316 10.4187/respcare.07487 148679316 ppf: 253 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects. aug: au: Hickmann, Cheryl E. Montecinos-Munoz, Natalia R. Castanares-Zapatero, Diego Arriagada-Garrido, Ricardo S. Jeria-Blanco, Ursula Gizzatullin, Timour Roeseler, Jean Dugernier, Jonathan Wittebole, Xavier Laterre, Pierre-François affil: Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium sug: subj: Critically Ill Patients Sitting Therapeutic Exercise Patient Bedside Oxygenation Lung Physiology Training Effect (Physiology) Human Prospective Studies Furniture Design Electric Impedance Respiration, Artificial Anoxemia Confidence Intervals Purposive Sample Randomized Controlled Trials Kruskal-Wallis Test Mann-Whitney U Test Pearson's Correlation Coefficient Spearman's Rank Correlation Coefficient Male Female Middle Age Aged Aged, 80 and Over Descriptive Statistics Treatment Outcomes Random Assignment Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: Early mobilization during critical illness is safe and has beneficial effects on functional outcomes. However, its impact on pulmonary function has not been thoroughly explored. We hypothesized that a sitting position out of bed coupled with exercise could result in an improvement in oxygenation and lung aeration. METHODS: The study was conducted on a cohort of adult subjects within a week of their admission to an ICU. Subjects were transferred to a chair and undertook a 15-min session of exercise, either active or passive. Subjects in the control group were only transferred to a chair. Electrical impedance tomography, a reliable bedside technique monitoring regional lung aeration and the distribution of ventilation, was continuously performed, and blood gases were assessed at baseline and 20 min post-exercise. RESULTS: The cohort included 40 subjects, 17 of whom were mechanically ventilated and 23 spontaneously breathing. The control group for each modality consisted of 5 mechanically ventilated or 5 spontaneously breathing subjects. Mild hypoxemia was present in 45% of the spontaneously breathing cohort, whereas the mechanically ventilated subjects demonstrated moderate (50%) or severe (12%) hypoxemia. Compared with the control group, early mobilization induced a significant increase in lung aeration. In mechanically ventilated subjects, lung aeration increased, especially in the anterior lung regions (mean impedance [95% CI]: T1 (baseline in bed) = 1,265 [691-1,839]; T2 (chair sitting) = 2,003 [1,042-2,963]; T3 (exercise) = 1,619 [810 2,427]; T4 (post exercise in chair) = 2,320 [1,186-3,455]). In spontaneously breathing subjects, lung aeration increased mainly in the posterior lung regions (mean impedance [95% CI]: T1 = 380 [124-637]; T2 = 655 [226-1,084]; T3 = 621 [335-906]; T4 = 600 [340-860]). PaO2/FIO2 increased, especially in subjects with lower PaO2/FIO2 at baseline (< 200) (133 ± 31 to 158 ± 48, P = .041). CONCLUSIONS: For critically ill subjects, a sitting position and exercise increased lung aeration and were associated with an improvement in PaO2/FIO2 in the more severely hypoxemic subjects. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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