Chair-Sitting Exercise Intervention Does Not Improve Respiratory Muscle Function in Mechanically Ventilated Intensive Care Unit Patients

Abstract

BACKGROUND: Chair-sitting may allow for more readily activated scalene, sternocleidomastoid, and parasternal intercostal muscles, and may raise and enlarge the upper thoracic cage, thereby allowing the thoracic cage to be more easily compressed. OBJECTIVE: To evaluate the effect of chair-sitting during exercise training on respiratory muscle function in mechanically ventilated patients. METHODS: We randomized 16 patients to a control group and 18 patients to a chairsitting group. The patients in the chair-sitting group were transferred by 2 intensive care unit nurses from bed to armchair and rested for at least 30 min, based on the individual patient's tolerance. We measured heart rate, blood pressure, S pO 2 , and respiratory rate. In the treatment group, before transferring the patient from bed to armchair, and 30 min after the completion of chair-sitting we measured respiratory muscle function variables, including the ratio of respiratory rate (f) to tidal volume (V T ), S pO 2 , maximum inspiratory pressure (P Imax ) and maximum expiratory pressure (P Emax ). In the control patients we took those same measurements while the patient was in semirecumbent position, before and after treatments, for at least 6 days or until the patient was discharged from the intensive care unit or died. RESULTS: The 2 groups did not significantly differ in age, sex, or clinical outcomes. Respiratory rate, V T , f/V T , S pO 2 , P Imax , and P Emax were not significantly better in the chair-sitting group. The study period significantly improved respiratory rate, V T , P Imax , and P Emax (all P < .001), but not f/V T . CONCLUSIONS: Six days of chair-sitting exercise training did not significantly improve respiratory muscle function in mechanically ventilated patients.

A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients

“…PCT did not elicit any significant changes in respiratory parameters in comparison to resting supine, results that concur with those found in a recent similar study [ 14 ]. This study also reported a significant increase in HR beyond activity completion.…”

“…Emerging evidence for early mobilisation demonstrates reduction in the number of ventilator days and hospital length of stay [ 7 , 8 ], as well as improving functional outcomes at hospital discharge [ 9 – 11 ]. Early mobilisation within this patient cohort involves a combination of passive exercise including positioning, joint range of movement, and hoist transfer to chair; and more active tasks including sitting on the edge of the bed (SOEOB), step transfer to a chair and ambulation [ 12 – 14 ].…”

Inspiratory Muscle Rehabilitation in Critically Ill Adults. A Systematic Review and Meta-Analysis

“…Other approaches included flow resistive training (one study) (55), diaphragmatic breathing exercises (two studies) (48,53), and biofeedback on respiratory pattern (one study) (39). More general physical therapy regimens were also studied for their effect on inspiratory muscle strength, including mobilization (48,56,58), postural training (36,42), and upper arm exercise (44). Some studies employed combinations of these techniques.…”

“…IMT was applied after 24 hours of mechanical ventilation (1 study) (35), once patients were awake and cooperative (1 study) (48), once the patient was transitioned to partially assisted ventilation (1 study) (34), once patients met readiness-to-wean criteria (5 studies) (37,38,41,49,50), once patients failed attempted weaning (12 studies) (39, 40, 45-47, 52-55, 57, 59, 60), or after liberation from ventilation (3 studies) (33,43,44). Four studies did not specify the timing of intervention (36,51,56,58). The duration of IMT varied widely between studies, ranging from 3 days to up to 6 weeks of therapy (Table 1).…”

Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults

“…Despite long-standing evidence that prolonged bed rest results in deconditioning [ 1 , 2 ], studies investigating the effectiveness of early progressive mobilization for ICU patients have only started appearing in the literature in the last 10 to 15 years [ 3 , 4 ]. While the earlier publications documented the feasibility, safety and physiological effects associated with the mobilization of ICU patients [ 5 - 8 ], point-prevalence studies [ 9 , 10 ] and controlled trials investigating the effectiveness of early progressive mobilization have been published in more recent years [ 11 - 16 ]. These studies, and concomitant systematic reviews [ 4 , 17 - 22 ], provide evidence that early progressive mobilization of adult ICU patients is feasible, safe, and may result in benefits including improved functional outcomes, and reduced ICU and hospital length of stay.…”