Exercise in intensive care units, safety and hemodynamic monitoring

Authors

DOI:

https://doi.org/10.33233/rbfe.v19i1.3981

Keywords:

exercise; intensive care units; patient safety

Abstract

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aimed to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, as long as respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.

Author Biography

Giulliano Gardenghi, CEAFi/GO

Scientific Coordinator of the ENCORE Hospital/GO, Scientific Coordinator of the Center for Advanced Studies and Integrated Training/GO, Technical Consultant at Lifecare/HUGOL - Burns Intensive Care Unit/GO, Technical Consultant at São Cristóvão Hospital e Maternity/SP Brazil

References

Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care 2014;18(6):658. https://doi.org/10.1186/s13054-014-0658-y

Pires-Neto RC, Pereira AL, Parente C, Sant'anna GN, Esposito DD, Kimura A et al. Characterization of the use of a cycle ergometer to assist in the physical therapy treatment of critically ill patients. Rev Bras Ter Intensiva 2013;25(1):39-43. https://doi.org/10.1590/S0103-507X2013000100008

Gardenghi G, Kushida CL, Cruz JB, Souza AH, Prudente ML, Moraes Junior A et al. Avaliação da segurança no uso de cicloergômetro para membros superiores no pós-operatório de cirurgia cardí­aca. Rev do DERC 2017;23(4):123.

Cordeiro AL, Barbosa AFN, Leitão LP, Araújo PAS, Carvalho S. Hemodynamic effects of training on cycle ergometer in patients in post operative cardiac surgery. Rev do DERC 2014;20(3):90-93.

Hirschhorn AD, Richards DA, Mungovan SF, Morris NR, Adams L. Does the mode of exercise influence recovery of functional capacity in the early postoperative period after coronary artery bypass graft surgery? A randomized controlled trial. Interact Cardiovasc Thorac Surg 2012;15(6):995-1003. https://doi.org/10.1093/icvts/ivs403

Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M et al. Safety of patient mobilization and rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis. Ann Am Thorac Soc 2017;14(5):766-77. https://doi.org/10.1513/AnnalsATS.201611-843SR

Hickmann CE, Castanares-Zapatero D, Bialais E, Dugernier J, Tordeur A, Colmant L et al. Teamwork enables high level of early mobilization in critically ill patients. Ann Intensive Care 2016;6(1):80. https://doi.org/10.1186/s13613-016-0184-y

Cassina T, Putzu A, Santambrogio L, Villa M, Licker MJ. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study. Ann Card Anaesth 2016;19(3):425-432. https://doi.org/10.4103/0971-9784.185524

Munshi L, Kobayashi T, DeBacker J, Doobay R, Telesnicki T, Lo V et al. Intensive care physiotherapy during extracorporeal membrane oxygenation for acute respiratory distress syndrome. Ann Am Thorac Soc 2017;14(2):246-253. https://doi.org/10.1513/AnnalsATS.201606-484OC

Justino CF, Santos DS, Vicentim TK, Alexandre L, Salomão R, Gardenghi G. Análise da tolerância ortostática e da variabilidade da frequência cardí­aca em indiví­duos portadores de HIV/AIDS. Rev Soc Cardiol Estado de São Paulo 2010;20(3 Supl A):26-30.

Gardenghi G, Balestra LF. Fisiopatologia da hipotensão postural e intolerância ortostática. Rev Pesqui Fisioter 2017;7(1):115-24.

Vollman KM. Understanding critically ill patients hemodynamic response to mobilization. using the evidence to make it safe and feasible. Crit Care Nurs Q 2013;36(1):17–27. https://doi.org/10.1097/CNQ.0b013e3182750767

Liu K, Ogura T, Takahashi K, Ohtake H, Fujiduka K et al. The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study. J Intensive Care 2018;6:10. https://doi.org/10.1186/s40560-018-0281-0

Published

2020-02-20