Kayambu G.1,2, Boots R.J.1,3, Paratz J.D.1,4
1The University of Queensland, Burns, Trauma & Critical Care Research Centre, School of Medicine, Brisbane, Australia, 2National University Hospital, Department of Rehabilitation, Singapore, Singapore, 3The Royal Brisbane and Women's Hospital, Department of Intensive Care Medicine, Brisbane, Australia, 4Griffith University, School of Allied Health Sciences, Brisbane, Australia
Background: Critically ill patients with systemic inflammation have impaired microcirculation and oxygenation to vital organs that is associated with poor prognosis. Early physical exercise strategies may modulate tissue microcirculation and oxygenation in patients with sepsis.
Purpose: To determine effects of early physical rehabilitation on tissue microcirculation and oxygenation in patients with sepsis syndromes.
Methods: Sixteen mechanically ventilated critically ill adults admitted to general intensive care unit with sepsis syndromes completed a pilot study on tissue oxygenation and microcirculation as part of a prospective double-blind randomised controlled trial investigating early physical rehabilitation in intensive care. A within participant pre-post design was used. Clinical demographic data and changes in tissue oxygenation were assessed at baseline and immediately post exercise using a Near Infra-Red Spectroscopy (NIRO) device on the thenar eminence to the assess percentage of oxygen in the muscle (StO2) and percentage of Muscle Oxygen Extraction Rate (MOER%) under both baseline and hyperaemic conditions. An Orthogonal Spectral Imaging (OPS) device was placed sublingually to measure the Microvascular Flow Index (MFI) and Capillary Density (CD) of the microcirculation.
Results: A trend of increased StO2 for hyperaemia was found following early exercise over 7 days (p=0.06). A large StO2 change from baseline to hyperaemic of 2.6% to 6.2% on Day 2 post exercise was noted. Across the week of exercise, a trend of improvement in hyperaemia post exercise between (5 to 6.2%) was noted from Day 1 to Day 2 upon implementing physical rehabilitation. Tissue oxygenation peaked at Day 2 but was found to be low by Day 7 (6.2% to 1.8%) with exercise. No statistical significance was reached pre and post exercise for microvascular flow index but a trend for improved capillary density was noted (2.46±1.04, 3.70±1.04, p=0.06).
Conclusion(s): Early physical rehabilitation in critically ill patients shows trends of improved microcirculatory and tissue oxygenation in the acute stages of sepsis upon ICU admission.
Implications: Early physical rehabilitation in intensive care is beneficial as it can modulate tissue oxygenation and microcirculation impairments during acute systemic inflammation in critically ill patients. The ability of early exercise to recruit microcirculation to enhance tissue oxygenation requires further investigation.
Funding acknowledgements: Intensive Care Foundation
National University Hospital
National University Hospital
Topic: Critical care
Ethics approval: The Human Research Ethics Committee; Royal Brisbane and Womens Hospital
The Medical Research Ethics Committee; The University of Queensland
All authors, affiliations and abstracts have been published as submitted.
