Passive motion of the lower extremities in sedated and ventilated patients in the ICU – a systematic review of early effects and replicability of Interventions

Abstract

Early mobilization, which includes active / passive motion in bed along with mobilization out of bed, is recommended to prevent the development of intensive care unit acquired-weakness (ICU-AW) for patients with critical illness on the intensive care unit. To date, the impact of passive motion of the lower extremities in sedated and ventilated patients remains unclear. The aim of the study is to systematically review and summarize the currently available randomized controlled trials in English or German language on the impact of passive motion of the lower extremities in sedated and ventilated patients ≥ 18 years in the intensive care unit on musculature, inflammation and immune system and the development of intensive care unit-acquired weakness and to evaluate the replicability of interventions and the methodological quality of included studies. A systematic literature search was performed up to 20th February 2022 in the databases Medline, Embase, Cochrane Library, CINAHL and PEDro. The description of the intervention (TIDieR checklist) and the methodological quality (Downs and Black checklist) were assessed. Five studies were included in the qualitative syntheses. On average, the studies were rated with 6.8 out of 12 points according to the TIDieR checklist. For the methodological quality an average of 19.8 out of 27 points on the Downs and Black checklist was reported. The results of included studies indicated that muscle loss may be reduced by passive manual movement, passive cycling and passive motion on a continuous passive motion-unit. In addition, positive effects were reported on the reduction of nitrosative stress and the immune response. The impact on the development of ICU-AW remains unclear. In conclusion, passive movement show a slight tendency for beneficial changes on cellular level in sedated and ventilated patients in the ICU within the first days of admission, which may indicate a reduction of muscle wasting and could prevent the development of ICU-AW. Future randomized controlled trials should use larger samples, use complete intervention description, use a comparable set of outcome measures, use rigorous methodology and examine the effect of passive motion on the development of ICU-AW.

Application effect of nutritional support combined with early motion based on protection motivation theory in ICU-acquired weakness

“…Moreover, according to the principles of the protective motivation theory, the benefits of early exercise for the recovery of mobility, functional independence, and self-care ability were explained to the participants. Concerns about movement safety was alleviated, and beliefs and confidence to participate in activities and resume movement were improved to inspire patients to overcome ICU-AW and critical illness [2,10]. An Randomized Controlled Trial (RCT) investigating the impact of an early progressive exercise program also suggests that a 1% increase in activity in the ICU may lead to a 35% increase in the likelihood of functional independence at discharge from the ICU [11], which is in line with this finding.…”

Mobilização Precoce Em Pacientes Internados Em Unidade De Terapia Intensiva: Revisão De Literatura

“…Quanto ao sexo, apenas dois estudos informaram as quantidades e/ou percentuais, quais sejam: população de 87 pessoas, sendo 49 homens e 19 mulheres, mais 19 não definidos (8) ; e 358 sujeitos, dos quais 53% (ou 190) são mulheres e 168 homens (9) . Apenas um estudo mencionou crianças e adultos integrando a população sem, no entanto, informar quantidade (10) .…”

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

“…assisted upper and lower limb exercises), or active (e.g. inspiratory muscle training, sitting, standing, marching on the spot, functional activities, cycle ergometry, or mobilisation/walking) [7][8][9][10][11][12].…”