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European Journal of Physical and Rehabilitation Medicine 2020 Jul 15

DOI: 10.23736/S1973-9087.20.06274-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Very early exercise tailored by using a decisional algorithm helps relieve discomfort in adults in an intensive care unit: an open-label pilot study

Hélène LAURENT 1, 2 , Sylvie AUBRETON 2, Aurélie VALLAT 2, Bruno PEREIRA 3, Bertrand SOUWEINE 4, Jean-Michel CONSTANTIN 5, Emmanuel COUDEYRE 1, 2

1 Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France; 2 Service de Médecine Physique et Réadaptation, CHU Clermont-Ferrand, Clermont-Ferrand, France; 3 DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France; 4 Service de Réanimation Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France; 5 Service de Réanimation Chirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France


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BACKGROUND: Existing algorithms do not allow for setting up finely tuned progression or intensity for exercise training in intensive care units (ICUs).
AIM: We aimed to assess the feasibility and tolerance of a very early exercise program tailored by using decisional algorithm that integrated both progression and intensity.
DESIGN: Open-label pilot study.
SETTING: ICU.
POPULATION: 30 adults hospitalized in ICU.
METHODS: Once a day, patients performed manual range of motion, cycloergometry, and functional training exercises. The progression and intensity of training were standardized by using the constructed algorithm. The main outcome, discomfort on a 0-100 visual analog scale, was assessed before and after each exercise session. Secondary outcomes were muscle strength, ICU length of stay and adverse events related to exercise.
RESULTS: In total, 125 exercise sessions were performed. Discomfort during exercise sessions decreased significantly by the fifth session (p=0.049). Early exercise sessions were feasible and did not produce major adverse events.
CONCLUSIONS: We confirmed the safety and feasibility of very early exercise programs in ICUs. Early exercise tailored by using a decisional algorithm helps relieve the discomfort of ICU patients.
CLINICAL REHABILITATION IMPACT: In everyday practice, the use of decisional algorithms should be encouraged to initiate and standardize early exercise in ICUs.


KEY WORDS: Algorithm; Early exercise; Intensive care unit; Physical therapy; Tolerance

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