The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients

Abstract

Early mobilization has become an important aspect of treatment in intensive care medicine, especially in patients with acute pulmonary dysfunction. As its effects on regional lung physiology have not been fully explored, we conceived a prospective observational study (Registration number: DRKS00023076) investigating regional lung function during a 15-min session of early mobilization physiotherapy with a 30-min follow-up period. The study was conducted on 20 spontaneously breathing adult patients with impaired pulmonary gas exchange receiving routine physical therapy during their intensive care unit stay. Electrical impedance tomography (EIT) was applied to continuously monitor ventilation distribution and changes in lung aeration during mobilization and physical therapy. Baseline data was recorded in the supine position, the subjects were then transferred into the seated and partly standing position for physical therapy. Afterward, patients were transferred back into the initial position and followed up with EIT for 30 min. EIT data were analyzed to assess changes in dorsal fraction of ventilation (%dorsal), end-expiratory lung impedance normalized to tidal variation (ΔEELI), center of ventilation (CoV) and global inhomogeneity index (GI index).Follow-up was completed in 19 patients. During exercise, patients exhibited a significant change in ventilation distribution in favor of dorsal lung regions, which did not persist during follow-up. An identical effect was shown by CoV. ΔEELI increased significantly during follow-up. In conclusion, mobilization led to more dorsal ventilation distribution, but this effect subsided after returning to initial position. End-expiratory lung impedance increased during follow-up indicating a slow increase in end-expiratory lung volume following physical therapy.

The influence of gravity on electrical impedance tomography measurements during upper body position change

“…The position of diaphragm differs at various upper body positions, which influences the lung volume [ 12 ]. The postural effects may improve lung function of ICU patients, as suggested in previous studies with EIT [ 13 , 14 ]. In these studies, EIT-derived parameters between supine and sitting positions were compared.…”

“…Since the lung regions became smaller and ventilation distributed towards dorsal part, the GI slightly increased in tilted positions. In general, gravity-dependent diaphragm displacement influenced the regional ventilation distribution and therefore, could be used on ICU patients for early rehabilitations [ 13 , 14 ]. In addition, the heart descended towards abdomen during the position change from supine to sitting.…”

An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation

“…8 Similarly, EIT (described elsewhere 9,10 ) can be used to personalize physiotherapy respiratory management and assess the outcomes of several physiotherapy treatments, including the effect of suctioning, lung hyperinflations, recruitment maneuvers, mobilization/exercise, ventilator weaning, positioning, mechanical insufflation-exsufflation (MI-E), and inspiratory muscle training. 9,[11][12][13][14][15][16][17] Physiotherapists are also often involved in both assessment and treatment of patients with weaning failure (see separate chapter for a detailed description of weaning from MV). Respiratory pump failure is considered to be one of the most common causes of weaning failure, 18,19 with pronounced diaphragm weakness observed in more than 60% of patients requiring MV.…”

“…8 Similarly, EIT (described elsewhere 9 10 ) can be used to personalize physiotherapy respiratory management and assess the outcomes of several physiotherapy treatments, including the effect of suctioning, lung hyperinflations, recruitment maneuvers, mobilization/exercise, ventilator weaning, positioning, mechanical insufflation–exsufflation (MI-E), and inspiratory muscle training. 9 11 12 13 14 15 16 17…”

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

“…It is recommended to perform daily sessions of spontaneous breathing during the sedation withdrawal in combination with verticalization manipulations added with active exercises for upper limbs to prevent respiratory ICU-acquired weakness in adult patients on CMV [74][75][76] (level of evidence -3, grade of recommendation -B).…”