Advances in intensive care and mechanical ventilation (MV) in the past two decades have increased critically ill patient survival. However, some patients require prolonged MV (PMV) and are deconditioned due to respiratory insufficiency caused by underlying disease, adverse effects of medications, and prolonged immobilization. Patients in the intensive care unit (ICU) are often confined to their beds, which results in inactivity, immobility, and severe osteomyoarticular system dysfunction. Our hypothesis is that an early mobilization protocol improves muscle thickness (MT) of the quadriceps femoris, peripheral muscle strength, perceived functional status, gait speed, quality of life, duration of mechanical ventilation, ICU length of stay of the critically ill patient. The purpose of this study is to evaluate the effects of implementation an early mobilization protocol in critically ill patients in the Intensive Care Unit of the University Hospital of Santa Maria.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
28
Patients in the treatment group additionally received a cycling exercise session 7 days a week, using a bedside cycle ergometer (MOTOmed Letto 2, RECK-Technik GmbH \& Co. KG, Betzenweiler, Germany). The device offers the possibility to conduct passive or active cycling at six levels of increasing resistance. The aim of each session was to have the patient cycle for 30 mins at an individually adjusted intensity level. Patients were placed in a comfortable position in between the supine and the semirecumbent position.
University Hospital of Santa Maria
Santa Maria, Rio Grande do Sul, Brazil
Muscle thickness (MT) of the quadriceps femoris.
MT of the quadriceps femoris will be assessed by ultrasonography (baseline and 14 day).
Time frame: Change from baseline at 14 day of ICU admission, an average of 1 month.
Muscle thickness (MT) of the diaphragm.
MT of the diaphragm will be assessed by ultrasonography (baseline and 14 day).
Time frame: Change from baseline at 14 day of ICU admission, an average of 1 month.
Rectus femoris cross-sectional area
Rectus femoris cross-sectional area will be assessed by ultrasonography (baseline and 14 day).
Time frame: Change from baseline at 14 day of ICU admission, an average of 1 month.
Vastus intermedius, rectus femoris and diaphragm echo intensity.
Vastus intermedius, rectus femoris and diaphragm echo intensity will be assessed by ultrasonography (baseline and 14 day)
Time frame: Change from baseline at 14 day of ICU admission, an average of 1 month.
Rectus femoris and vastus intermedius thickness.
Rectus femoris and vastus intermedius thickness will be assessed by ultrasonography (baseline and 14 day).
Time frame: Change from baseline at 14 day of ICU admission, an average of 1 month.
Muscle strength
Muscle strength in arms and legs will be measured by the Medical Research Council (MRC) scale.
Time frame: First day of the patient was cooperative and responsive and at day 14 of ICU admission, an average of 1 month.
Gait speed
Gait speed will be measured by the six-meter gait speed test (GST)
Time frame: Study completion, an average of 2 months (hospital discharge)
Peripheral muscle strength of the lower limbs
Peripheral muscle strength of the lower limbs will be measured by 30 second chair stand test
Time frame: Study completion, an average of 2 months (hospital discharge)
Quality of life following hospital discharge
Quality of life will be measured by a questionnaire 36-item Short Form Health Survey
Time frame: Three months after hospital discharge SF36
Mortality
Time frame: Patients will be followed until three months after hospital discharge
ICU length of stay
Time frame: Patients will be followed until ICU discharge, an expected 2 days to 3 weeks.
Weaning Acceleration
Time frame: Patients will be followed until ICU discharge, an expected 2 days to 3 weeks
Side effects of mobilization protocol
Haemodynamic response to mobilization. Response in systolic and diastolic blood pressure. Response in heart rate. Response in peripheral oxygen saturation.
Time frame: During and 30 minutes after mobilization therapy during ICU stay, approximately 1 to 2 weeks.
Length of hospital stay
Time frame: Patients will be followed until hospital discharge, an expected 4 to 6 weeks
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