Feasibility of Exercise Testing in Patients Who Are Critically Ill: A Prospective, Observational Multicenter Study

Sommers, Juultje; Klooster, Emily; Zoethout, Siebrand B.; Oever, Huub L. A. van den; Nollet, Frans; Tepaske, Robert; Horn, Janneke; Engelbert, Raoul; Schaaf, Marike van der

doi:10.1016/j.apmr.2018.07.430

Cited by 20 publications

(16 citation statements)

References 39 publications

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“…14 Specifically, IF may lower the amount of resistance exercise necessary to induce an anabolic effect, and therefore combined interventions might be studied. 58,59 IF may also help establish a normal circadian rhythm for these patients, and may be included in trials of interventions intended to have this effect. 60 Second, a role for IF in the optimization of nutritional delivery needs to be explored, as this may be a pragmatic, inexpensive, safe, and easily implemented method by which to ensure patients receive the nutrition they require.…”

Section: Continuous Feedingmentioning

confidence: 99%

Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness

McNelly

Bear

Connolly

et al. 2020

Chest

106

165

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Section: Continuous Feedingmentioning

confidence: 99%

Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness

McNelly

Bear

Connolly

et al. 2020

Chest

106

165

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“…According to recent international guidelines, “serious safety events or harms do not occur commonly during physical rehabilitation or mobilization” (Devlin et al, 2018). The safety of our exercise protocol was addressed in a previous publication (Sommers et al, 2019) and was comparable to the safety of early mobilization in general. Though active mobilization of ICU patients beyond the AT has not been described before, it is likely that in practice, many patients have crossed that boundary unknowingly.…”

Section: Discussionmentioning

confidence: 62%

“…The exercise tolerance in our patients was consistent with other CPET studies in ICU patients. In a CPET study with 28 mixed ICU patients the

{\overset{V}{true} normalO}_{2}

increased from 291 to 384 ml/min, corresponding to 1.32 MET (Sommers et al, 2019). Another study reported a

{\overset{V}{true} normalO}_{2}

increase from 249 to 337 L/min, corresponding to 1.35 MET (Akoumianaki et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of critical care ergometry: Exercise data of patients on mechanical ventilation analyzed as nine‐panel plots

Oever

Kök

Oosterwegel

et al. 2022

Physiological Reports

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Nine‐panel plots are standard displays of cardiopulmonary exercise data, used in cardiac and pulmonary medicine to investigate the nature of exercise limitation. We explored whether this approach could be used to analyze the data of critically ill patients on mechanical ventilation, capable of exercising actively. Patients followed an incremental exercise protocol using a bedside cycle ergometer. Respiratory gases were analyzed using indirect calorimetry, and blood gases were sampled from arterial catheters. Data of seven patients were combined into nine‐panel plots. Systematic analysis clarified the nature of exercise limitation in six cases. Resting metabolic rate was increased in all patients, with a median oxygen uptake (trueV˙normalO2) of 5.52 (IQR 4.29–6.31) ml/kg/min. Unloaded cycling increased the trueV˙normalO2 by 19.8% to 6.61 (IQR 5.99–7.08) ml/kg/min. Adding load to the ergometer increased the trueV˙normalO2 by another 20.0% to reach trueV˙normalO2peak at a median of 7.14 (IQR 6.67–10.75) ml/kg/min, corresponding to a median extrinsic workload of 7 W. This was accompanied by increased CO2 production, respiratory minute volume, heart rate, and oxygen pulse. Three patients increased their trueV˙normalO2 to >40% of predicted trueV˙normalO2truemax, two patients passed the anaerobic threshold. Dead space ventilation was 44%, decreasing to 42% and accompanied by lower ventilatory equivalents during exercise. Exercise produced no net change in alveolo‐arterial PO2 difference. We concluded that diagnostic ergometry in mechanically ventilated patients was feasible. Analysis of the data as nine‐panel plots provided insight into individual limitations to exercise.

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“…Jonghe JAMA 2002. Further, critically ill patients are unable to exercise sufficiently to stimulate an anabolic state, demonstrating a significantly lower exercise tolerance than healthy controls (Sommers et al 2019). Lastly most trials assume population homogeneity, and unsurprisingly, the presence of heterogeniety e.g.…”

Section: Add Dementioning

confidence: 99%

“…Lastly most trials assume population homogeneity, and unsurprisingly, the presence of heterogeniety e.g. chronic disease states, frailty and age are modifiers to patients response to exercise (Puthucheary and Denehy 2015;Sommers et al 2019).…”

Section: Add Dementioning

confidence: 99%

Muscle wasting in the critically ill patient: how to minimise subsequent disability

Flower

Puthucheary

2020

Br J Hosp Med

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Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2–3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.

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Feasibility of Exercise Testing in Patients Who Are Critically Ill: A Prospective, Observational Multicenter Study

Cited by 20 publications

References 39 publications

Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness

Effect of Intermittent or Continuous Feed on Muscle Wasting in Critical Illness

Feasibility of critical care ergometry: Exercise data of patients on mechanical ventilation analyzed as nine‐panel plots

Muscle wasting in the critically ill patient: how to minimise subsequent disability

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