Exercise as early mobilization in patients using vasoactive drugs
DOI:
https://doi.org/10.33233/rbfex.v19i4.4249Keywords:
vasodilator agents; early ambulation; intensive care units; physical therapy specialtyAbstract
Introduction: The functional benefits of early mobilization (PM) capable of minimizing limitations and deformities due to immobility are obvious, but many barriers to conducting PM as a routine practice are present in the intensive care unit (ICU), including the use of vasoactive drugs (VAD), directly related to the weakness acquired in the ICU, in addition to the presence of resistance from the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this review was to raise scientific basis in the management of critically ill patients using VAD for PM in the ICU. Methods: Integrative review of articles published between 2011 and 2018 in the following databases: PEDro, Pubmed, Lilacs, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in ICU, vasopressor and their equivalents in Portuguese. Results: Nine studies analyzing the intervention of PM in patients using VAD, with or without ventilatory support, were included. There was not a homogeneous treatment among the studies, varying between exercises in and outside bed, with passive and/or active action. However, regardless of the conduct, he cardiovascular response improved without relevant changes regarding the use of VAD. Conclusion: PM is not contraindicated for patients in ICU using VAD and proved to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes that would determine its absolute contraindication.
References
Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J et al. Feasibility and inter-rater reliability of the ICU Mobility. Heart Lung 2014;43(1):19-24. doi: 10.1016/j.hrtlng.2013.11.003
Camargo JBG, Cavenaghi OM, Mello JRC, Brito MVC, Ferreira LL. Mobilidade funcional de pacientes críticos em terapia intensiva: um estudo piloto. Revista de Atenção à Saúde 2020;18(63):14-20.
Aquim EE, Bernardo WM, Buzzini RF, Azeredo NAG, Cunha LS, Damasceno MCP et al. Diretrizes Brasileiras para Mobilização Precoce em Unidade de Terapia Intensiva. Rev Bras Ter Intensiva 2019;31(4):434-43. doi: 10.5935/0103-507x.20190084
Timenetsky KT, Neto AS, Assunção MSC, Taniguchi L, Eid RAC, Corrêa TD. Mobilization practices in the ICU: A nationwide 1-day point- prevalence study in Brazil. PLoS ONE 2020;15(4):e0230971. doi: 10.1371/journal.pone.0230971
Hashem MD, Nelliot A, Needham DM. Early mobilization and rehabilitation in the ICU: moving back to the future. Respiratory Care 2016;61(7):971-9. doi: 10.4187/respcare.04741
Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilization and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 2017;43:171-83. doi: 10.1007/s00134-016-4612-0
Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner EA, Chipman DW, et al. Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM&R 2011;3(4):307-13. doi: 10.1016/j.pmrj.2010.12.022.
Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, Hopkins RO et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 2011;341(5):373-7. doi: 10.1097/MAJ.0b013e31820ab4f6.
Fontela PC, Lisboa TC, Forgiarini-Júnior LA, Friedman G. Early mobilization practices of mechanically ventilated patients: a 1-day point-prevalence study in southern Brazil. Clinics 2018;73:e241. http://doi.org/10.6061/clinics/2018/e241
Feliciano VA, Albuquerque CG, Andrade FMD, Dantas CM, Lopez A, Ramos FF et al. A influência da mobilização precoce no tempo de internamento na Unidade de Terapia Intensiva. ASSOBRAFIR Ciência 2012;3(2):31-42
Pires-Neto RC, Lima NP, Cardim GM, Park M, Denehy L. Early mobilization practice in a single Brazilian Intensive Care Unit. J Crit Care 2015;30(5):896-900. doi: 10.1016/j.jcrc.2015.05.004
Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L, Harrold M et al. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 2015;19(1):81. doi: 10.1186/s13054-015-0765-4
McWilliams D, Jones C, Atkins G, Hodson J, Whitehouse T, Veenith T, Reeves E, et al. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: a feasibility randomised controlled trial. J Crit Care 2018;44:407-12. doi: 10.1016/j.jcrc.2018.01.001
Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, Miller RR, Ringwood N, et al. Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med 2017;45(2):205-15. doi: 10.1097/CCM.0000000000002058
Liu K, Ogura T, Takahashi K, Nakamura M, Ohtake H, Fujiduka K, Abe E, Oosaki H, et al. The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study. J Int Care 2018;(6):10. doi: 10.1186/s40560-018-0281-0
Mendonça LBA, Madeiro AC, Lima FET, Barbosa IV, Brito MEM, Cunha LGP. Uso de catecolaminas de infusão contínua em pacientes de unidade de terapia intensiva. Rev Enferm UFPE on line 2012;6(1):26-31.
Fonseca JCL. Drogas vasoativas – Uso racional. Rev Soc Cardiol 2001;14:49-53.
Ostini FM, Antoniazzi P, Filho AP, Bestetti R, Cardoso MCM, Filho AB. O uso de drogas vasoativas em terapia intensiva. Simpósio: Medicina Intensiva: I. Infecção e choque; 1998;31:400-11.
Udesen NLJ, Helgestad OKL, Banke ABS, Frederiksen PH, Josiassen J, Jensen LO et al. Impact of concomitant vasoactive treatment and mechanical left ventricular unloading in a porcine model of profound cardiogenic shock. Crit Care 2020;24(1):95. doi: 10.1186/s13054-020-2816-8
Wolfe KS, Patel BK, MacKenzie EG, Giovanni SP, Pohlman AS, Churpek MM et al. Impact of vasoactive medications on ICU-acquired weakness in mechanically ventilated patients. Chest 2018;154(4):781-7. doi: 10.1016/j.chest.2018.07.016
Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther 2014;20(3),249-60. doi: 10.1177/1074248414559838
Conceição TMA, Gonzáles AI, Figueiredo FCXS, Vieira DSR, Bündchen DC. Critérios de segurança para iniciar uma mobilização precoce em unidades de terapia intensiva. Revisão sistemática. Rev Bras Ter Intensiva 2017;29(4):509-19. doi: 10.5935/0103-507x.20170076.
Fontanela PC, Jr Forgiarini LA, Friedman G. Atitudes clínicas e barreiras percebidas para a mobilização precoce de pacientes graves em unidades de terapia intensiva adulto. Rev Bras Ter Intensiva 2018;30(2);187-194. doi: 10.5935/0103-507x.20180037
Gardenghi G, Kushida CL, Dias AB, Cruz JB, Lima KR, Souza AH. Estudo piloto da viabilidade no uso de cicloergômetro para membros superiores no primeiro dia pós-operatório de cirurgia cardíaca. Rev Pesqui Fisioter 2019;9(2):179-86. doi: 10.17267/2238-2704rpf.v9i2.2303
Boyd J, Paratz J, Tronstad O, Caruana L, McCormack P, Walsh J. When is it safe to exercise mechanically ventilated patients in the intensive care unit? An evaluation of consensus recommendations in a cardiothoracic setting. Heart Lung 2018;47(2):81-6. doi: 10.1016/j.hrtlng.2017.11.006
Pires-Neto RC, Kawaguchi YMF, Hirota AS, Fu C, Tanaka C, Caruso P et al. Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects - A case series. PLoS One 2013;8(9):e74182. doi: 10.1371/journal.pone.0074182
Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, Gabbe B et al. A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Crit Care Med 2016;44(6):1145-52. doi: 10.1097/CCM.0000000000001643
Genc A, Koca U, Ali G. What are the hemodynamic and respiratory effects of passive limb exercise for mechanically ventilated patients receiving low-dose vasopressor / inotropic support? Crit Care Nurs Q 2014;37(2):152-8. doi: 10.1097/CNQ.0000000000000013
Hodgson C, Stiller K, Needham D, Tipping C, Harrold M, Baldwin C, Bradley S, et al. Expert Consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014;18(6):658.
Downloads
Additional Files
Published
Issue
Section
License
Copyright (c) 2020 Amanda Mariano Morais, Daiane Naiara da Penha, Danila Gonçalves Costa, Vanessa Beatriz Aparecida Fontes Schweling, Jaqueline Aparecida Almeida Spadari, Giulliano Gardenghi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms: Authors retain the copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License which allows the sharing of work with acknowledgment of authorship and initial publication in this magazine; Authors are authorized to assume additional contracts separately, for non-exclusive distribution of the version of the work published in this journal (eg, publish in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal; Authors are allowed and encouraged to publish and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can generate productive changes as well as increase impact and citation of published work (See The Effect of Open Access).
