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OBJECTIVE: To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil. DESIGN: This is a retrospective cohort study. SETTING: A Brazilian educational and research-intensive care unit (ICU). PARTICIPANTS: A total of 1047 patients were hospitalized from May 2016 to April 2018. INTERVENTIONS: Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP). MAIN OUTCOME MEASURES: Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP. RESULTS: There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40). CONCLUSIONS: Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.
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RESUMO Objetivo: Investigar a influência de uma sessão de mobilização passiva na função endotelial de pacientes com sepse. Métodos: Este foi um estudo quase-experimental duplo-cego e de braço único com desenho pré e pós-intervenção. Participaram 25 pacientes com diagnóstico de sepse hospitalizados em unidade de terapia intensiva. Avaliou-se a função endotelial basal (pré-intervenção) e imediatamente pós-intervenção por meio de ultrassonografia da artéria braquial. Foram obtidas a dilatação mediada pelo fluxo, a velocidade pico de fluxo sanguíneo e a taxa de cisalhamento pico. A mobilização passiva consistiu na mobilização bilateral (tornozelos, joelhos, quadris, pulsos, cotovelos e ombros), com três séries de dez repetições cada, totalizando 15 minutos. Resultados: Após a mobilização, encontramos aumento da função de reatividade vascular em relação à pré-intervenção: dilatação mediada pelo fluxo absoluta (0,57mm ± 0,22 versus 0,17mm ± 0,31; p < 0,001) e dilatação mediada pelo fluxo relativa (17,1% ± 8,25 versus 5,08% ± 9,16; p < 0,001). O pico de fluxo sanguíneo na hiperemia (71,8cm/s ± 29,3 versus 95,3cm/s ± 32,2; p < 0,001) e a taxa de cisalhamento (211s ± 113 versus 288s ± 144; p < 0,001) também aumentaram. Conclusão: Uma sessão de mobilização passiva foi capaz de aumentar a função endotelial em pacientes graves com sepse. Estudos futuros são necessários para investigar se um programa de mobilização pode ser aplicado como intervenção benéfica para melhorar clinicamente a função endotelial em pacientes hospitalizados por sepse.
ABSTRACT Objective: To investigate the influence of a passive mobilization session on endothelial function in patients with sepsis. Methods: This was a quasi-experimental double-blind and single-arm study with a pre- and postintervention design. Twenty-five patients with a diagnosis of sepsis who were hospitalized in the intensive care unit were included. Endothelial function was assessed at baseline (preintervention) and immediately postintervention by brachial artery ultrasonography. Flow mediated dilatation, peak blood flow velocity and peak shear rate were obtained. Passive mobilization consisted of bilateral mobilization (ankles, knees, hips, wrists, elbows and shoulders), with three sets of ten repetitions each, totaling 15 minutes. Results: After mobilization, we found increased vascular reactivity function compared to preintervention: absolute flow-mediated dilatation (0.57mm ± 0.22 versus 0.17mm ± 0.31; p < 0.001) and relative flow-mediated dilatation (17.1% ± 8.25 versus 5.08% ± 9.16; p < 0.001). Reactive hyperemia peak flow (71.8cm/s ± 29.3 versus 95.3cm/s ± 32.2; p < 0.001) and shear rate (211s ± 113 versus 288s ± 144; p < 0.001) were also increased. Conclusion: A passive mobilization session increases endothelial function in critical patients with sepsis. Future studies should investigate whether a mobilization program can be applied as a beneficial intervention for clinical improvement of endothelial function in patients hospitalized due to sepsis.
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Sepsis is a serious organ dysfunction leading to endothelial damage in critical patients. Physiologically, there is an augment of vascular diameter in response to increased vascular blood flow and shear stress stimulus. However, the pattern of vascular response in face of passive mobilization (PM), an early mobilization physical strategy, has not yet been explored in patients with sepsis. To explore patterns of vascular response to PM and associations with clinical and cardiovascular profile in patients with sepsis. Cross-sectional, single-arm study. Thirty-two patients diagnosed with sepsis were enrolled. Vascular response was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound, before and after PM. The PM (to assess the response pattern) and SR (shear rate) were also calculated. PM protocol consisted of knees, hips, wrists, elbows, shoulders, dorsiflexion/plantar flexion movements 3 × 10 repetitions each (15 min). Arterial stiffness was assessed by Sphygmocor®, by analyzing the morphology and pulse wave velocity. Cardiac autonomic modulation (CAM) was assessed by analyzing heart rate variability indexes (mean HR, RMSSD, LF, HF, ApEn, SampEn, DFA). Different vascular responses were observed after PM: (1) increased vascular diameter (responders) (n = 13, %FMD = 11.89 ± 5.64) and (2) reduced vascular diameter (non-responders) (n = 19, %FMD= -7.42 ± 6.44). Responders presented a higher non-linear DFA2 index (p = 0.02). There was a positive association between FMD and DFA (r = 0.529; p = 0.03); FMD and SampEn (r = 0.633; p < 0.01). A negative association was identified between FMD and LF (Hz) (r= -0.680; p < 0.01) and IL-6 (r= -0.469; p = 0.037) and SR and CRP (r= -0.427; p = 0.03).
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Análisis de la Onda del Pulso , Sepsis , Velocidad del Flujo Sanguíneo/fisiología , Arteria Braquial/diagnóstico por imagen , Estudios Transversales , Endotelio Vascular , Humanos , Valor Predictivo de las Pruebas , Flujo Sanguíneo Regional/fisiología , Estrés Mecánico , VasodilataciónRESUMEN
OBJECTIVE: To investigate the influence of a passive mobilization session on endothelial function in patients with sepsis. METHODS: This was a quasi-experimental double-blind and single-arm study with a pre- and postintervention design. Twenty-five patients with a diagnosis of sepsis who were hospitalized in the intensive care unit were included. Endothelial function was assessed at baseline (preintervention) and immediately postintervention by brachial artery ultrasonography. Flow mediated dilatation, peak blood flow velocity and peak shear rate were obtained. Passive mobilization consisted of bilateral mobilization (ankles, knees, hips, wrists, elbows and shoulders), with three sets of ten repetitions each, totaling 15 minutes. RESULTS: After mobilization, we found increased vascular reactivity function compared to preintervention: absolute flow-mediated dilatation (0.57mm ± 0.22 versus 0.17mm ± 0.31; p < 0.001) and relative flow-mediated dilatation (17.1% ± 8.25 versus 5.08% ± 9.16; p < 0.001). Reactive hyperemia peak flow (71.8cm/s ± 29.3 versus 95.3cm/s ± 32.2; p < 0.001) and shear rate (211s ± 113 versus 288s ± 144; p < 0.001) were also increased. CONCLUSION: A passive mobilization session increases endothelial function in critical patients with sepsis. Future studies should investigate whether a mobilization program can be applied as a beneficial intervention for clinical improvement of endothelial function in patients hospitalized due to sepsis.
OBJETIVO: Investigar a influência de uma sessão de mobilização passiva na função endotelial de pacientes com sepse. MÉTODOS: Este foi um estudo quase-experimental duplo-cego e de braço único com desenho pré e pós-intervenção. Participaram 25 pacientes com diagnóstico de sepse hospitalizados em unidade de terapia intensiva. Avaliou-se a função endotelial basal (pré-intervenção) e imediatamente pós-intervenção por meio de ultrassonografia da artéria braquial. Foram obtidas a dilatação mediada pelo fluxo, a velocidade pico de fluxo sanguíneo e a taxa de cisalhamento pico. A mobilização passiva consistiu na mobilização bilateral (tornozelos, joelhos, quadris, pulsos, cotovelos e ombros), com três séries de dez repetições cada, totalizando 15 minutos. RESULTADOS: Após a mobilização, encontramos aumento da função de reatividade vascular em relação à pré-intervenção: dilatação mediada pelo fluxo absoluta (0,57mm ± 0,22 versus 0,17mm ± 0,31; p < 0,001) e dilatação mediada pelo fluxo relativa (17,1% ± 8,25 versus 5,08% ± 9,16; p < 0,001). O pico de fluxo sanguíneo na hiperemia (71,8cm/s ± 29,3 versus 95,3cm/s ± 32,2; p < 0,001) e a taxa de cisalhamento (211s ± 113 versus 288s ± 144; p < 0,001) também aumentaram. CONCLUSÃO: Uma sessão de mobilização passiva foi capaz de aumentar a função endotelial em pacientes graves com sepse. Estudos futuros são necessários para investigar se um programa de mobilização pode ser aplicado como intervenção benéfica para melhorar clinicamente a função endotelial em pacientes hospitalizados por sepse.
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Hiperemia , Sepsis , Humanos , Endotelio Vascular , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/fisiología , Sepsis/terapia , Ambulación Precoz , Velocidad del Flujo Sanguíneo/fisiologíaRESUMEN
The aim of this study was to compare if an acute exercise session of high-load resistance training (HL-RT, e.g. 70% of 1 repetition-maximum, 1â RM) induces a higher magnitude of muscle damage compared with a RT protocol with low-loads (e.g. 20% 1â RM) associated with partial blood flow restriction (LL-BFR), and investigate the recovery in the days after the protocols. We used an unilateral crossover research design in which 10 young women (22(2)â y; 162(5)â cm; 66(11)â kg) performed HL-RT and LL-BFR in a randomized, counterbalanced manner with a minimum interval of 2 weeks between protocols. Indirect muscle damage markers were evaluated before and once a day for 4 days into recovery. Main results showed decreases of 8-12% at 24-48â h in maximal voluntary isometric and concentric contraction torques (P < 0.03), and changes in muscle architecture markers (P < 0.03) for HL-RT and LL-BFR, with no differences between protocols (P > 0.05). Moreover, delayed onset muscle soreness increased only after LL-BFR (P < 0.001). We conclude that an acute bout of low volume HL-RT or LL-BFR to failure resulted in edema-induced muscle swelling, but do not induce major or long-lasting decrements in muscle function and the level of soreness promoted from LL-BFR was mild.
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Fuerza Muscular , Músculo Esquelético/fisiopatología , Mialgia/fisiopatología , Flujo Sanguíneo Regional , Entrenamiento de Fuerza/métodos , Constricción , Estudios Cruzados , Femenino , Humanos , Músculo Esquelético/irrigación sanguínea , Adulto JovenRESUMEN
BACKGROUND AND AIM: Sepsis is associated with marked alterations in hemodynamic responses, autonomic dysfunction and impaired vascular function. However, to our knowledge, analysis of noninvasive markers to identify greater risk of death has not yet been investigated. Thus, our aim was to explore the prognostic utility of cardiac output (CO), stroke volume (SV), indices of vagal modulation (RMSSD and SD1), total heart rate variability (HRV) indices and FMD of brachial artery (%FMD), all measured noninvasively, in the first 24 hours of the diagnosis of sepsis. METHODS: 60 patients were recruited at ICU between 2015 and 2017 and followed by 28 days. CO, SV, RR intervals were measurement. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response were obtained (%FMD). Patients were divided by survivors (SG) and nonsurvivors groups (NSG). RESULTS: A total of 60 patients were analysed (SG = 21 and NSG = 39). Survivors were younger (41±15 years vs. 55±11 years) and used less vasoactive drugs. As expected, APACHE and SOFA scores were lower in NSG compared to SG. In addition, higher SD1, triangular index, % FMD, velocity baseline and hyperemia flow velocity as well as lower HR values were observed in the SG, compared to NSG (P<0.05). Interestingly, RMSSD and SD1 indices were independent predictors of %FMD, ΔFMD and FMDpeak. RMSSD threshold of 10.8ms and %FMD threshold of -1 were optimal at discriminatomg survivors and nonsurvivors. CONCLUSION: Noninvasive measurements of autonomic and endotelial function may be important markers of sepsis mortality, which can be easily obtained in the early stages of sepsis at the bedside.