Short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock

Abstract

BackgroundActive mobilization is not possible in patients under deep sedation and unable to follow commands. In this scenario, passive therapy is an interesting alternative. However, in patients with septic shock, passive mobilization may have risks related to increased oxygen consumption. Our objective was to evaluate the impact of passive mobilization on sublingual microcirculation and systemic hemodynamics in patients with septic shock.MethodsWe included patients who were older than 18 years, who presented with septic shock, and who were under sedation and mechanical ventilation. Passive exercise was applied for 20 min with 30 repetitions per minute. Systemic hemodynamic and microcirculatory variables were compared before (T0) and up to 10 min after (T1) passive exercise. p values <0.05 were considered significant.ResultsWe included 35 patients (median age [IQR 25–75%]: 68 [49.0–78.0] years; mean (±SD) Simplified Acute Physiologic Score (SAPS) 3 score: 66.7 ± 12.1; median [IQR 25–75%] Sequential Organ Failure Assessment (SOFA) score: 9 [7.0–12.0]). After passive mobilization, there was a slight but significant increase in proportion of perfused vessels (PPV) (T0 [IQR 25–75%]: 78.2 [70.9–81.9%]; T1 [IQR 25–75%]: 80.0 [75.2–85.1] %; p = 0.029), without any change in other microcirculatory variables. There was a reduction in heart rate (HR) (T0 (mean ± SD): 95.6 ± 22.0 bpm; T1 (mean ± SD): 93.8 ± 22.0 bpm; p < 0.040) and body temperature (T0 (mean ± SD): 36.9 ± 1.1 °C; T1 (mean ± SD): 36.7 ± 1.2 °C; p < 0.002) with no change in other systemic hemodynamic variables. There was no significant correlation between PPV variation and HR (r = −0.010, p = 0.955), cardiac index (r = 0.218, p = 0.215) or mean arterial pressure (r = 0.276, p = 0.109) variation.ConclusionsIn patients with septic shock after the initial phase of hemodynamic resuscitation, passive exercise is not associated with relevant changes in sublingual microcirculation or systemic hemodynamics.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0318-x) contains supplementary material, which is available to authorized users.

Impact of Early Passive Exercise With Cycle Ergometer on Ventilator Interaction

“…As previously reported by other authors, 9,27 hemodynamic parameters remained stable during exercise without any clinically relevant deterioration of heart rate, arterial pressure, and lactate levels. Pires-Neto et al 9 also studied hemodynamic behavior in sedated critically ill subjects during passive cycling exercise and reported similar results.…”

A national survey in United Arab Emirates on practice of passive range of motion by physiotherapists in intensive care unit

“…Passive limb range of motion exercises can be administered to patients in ICU to increase proportion of perfused vessels [18] and strength of the muscles [19,20]. They can also decrease the pain, cytokine levels [21] and incidence of ICU acquired weakness [22] without having any significant hemodynamic changes, even in mechanically ventilated patients [16,18,21].…”

Early passive mobilization increases vascular reactivity response in critical patients with sepsis: a quasi-experimental study

“…Exclusion criteria included medium-high dose of norepinephrine (≥ 0.5mcg/kg/minute), coagulopathy (prothrombin time > 2.5 times the normative values; activated partial thromboplastin time > 2 times the normal; or platelet count ≤ 50.000/µL), anticoagulant therapy with heparin intravenous infusion ≥ 2UI/mL, persistent arrhythmias, recent myocardial infarction (< 6 months), presence of pacemakers, intracranial hypertension, body mass index greater than 40kg/m 2 , cancer chemotherapy, unconsolidated fracture, pregnancy, anemia, amputation, deep vein thrombosis or phlebitis, musculoskeletal deformity, and compartment syndrome. ( 11 )…”

“…Three sets of ten repetitions were performed for each joint with a resting interval of 15 seconds between sets and 30 seconds to change joints. The frequency of the movements was maintained using a digital metronome (KORG, Inagi, TK, Japan) ( 11 ) with a count of 64 beeps per minute, with a beep for flexion and a beep for extension. Each joint was mobilized for approximately 1 minute, totaling 6 minutes of joint movement and 12 minutes of the experimental protocol.…”