Intensive Care Medicine

, Volume 41, Issue 5, pp 865–874 | Cite as

Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial

Original

Abstract

Rationale

Survivors of sepsis syndromes have poor outcomes for physical and cognitive function. No investigations of early physical rehabilitation in the intensive care unit have specifically targeted patients with sepsis syndromes.

Objective

To determine whether early physical rehabilitation improves physical function and associated outcomes in patients with sepsis syndromes.

Methods

Fifty critically ill adults admitted to a general intensive care unit with sepsis syndromes were recruited into a prospective double-blinded randomised controlled trial investigating early physical rehabilitation.

Measurements

Primary outcomes of physical function (acute care index of function) and self-reported health-related quality of life were recorded at ICU discharge and 6 months post-hospital discharge, respectively. Secondary measures included inflammatory biomarkers; Interleukin-6, Interleukin-10 and tumour necrosis factor-α, blood lactate, fat-free muscle mass, exercise capacity, muscle strength and anxiety.

Main results

A significant increase in patient self-reported physical function (81.8 ± 22.2 vs. 60.0 ± 29.4), p = 0.04) and physical role (61.4 ± 43.8 vs. 17.1 ± 34.4, p = 0.005) for the SF-36 at 6 months was found in the exercise group. Physical function scores were not significantly different between groups. Muscle strength scores were (51.9 ± 10.5 vs. 47.3 ± 13.6, p = 0.24) with the standard care mean Medical Research Council Muscle Score (MRC) <48/60. The mean change of Interleukin-10 increased and was significantly higher in the exercise group (1.8 pg/ml, 180 % vs. 0.9 pg/ml, 90 %, p = 0.04). There was no significant difference between groups for lactate, Interleukin-6, tumour necrosis factor-α, muscle strength, exercise capacity, fat-free mass or hospital anxiety.

Conclusion

Implementation of early physical rehabilitation can improve self-reported physical function and induce systemic anti-inflammatory effects.

Keywords

Physiotherapy Critical care Exercise therapy 

Supplementary material

134_2015_3763_MOESM1_ESM.doc (332 kb)
Supplementary material 1 (DOC 331 kb)
134_2015_3763_MOESM2_ESM.doc (100 kb)
Supplementary material 2 (DOC 100 kb)

References

  1. 1.
    Danai P, Martin GS (2005) Epidemiology of sepsis: recent advances. Curr Infect Dis Rep 7:329–334CrossRefPubMedGoogle Scholar
  2. 2.
    Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Rommes JH, Bakker J (2008) The impact of severe sepsis on health-related quality of life: a long-term follow-up study. Anesth Analg 107:1957–1964CrossRefPubMedGoogle Scholar
  3. 3.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Jones C (2013) What’s new on the post-ICU burden for patients and relatives? Intensive Care Med 39:1832–1835CrossRefPubMedGoogle Scholar
  5. 5.
    Kayambu G, Boots RJ, Paratz JD (2013) Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 41:1543–1554CrossRefPubMedGoogle Scholar
  6. 6.
    Parry S, Berney S, Granger C, Koopman R, El-Ansary D, Denehy L (2013) Electrical muscle stimulation in the intensive care setting: a systematic review. Crit Care Med 41:2406–2418CrossRefPubMedGoogle Scholar
  7. 7.
    Maffiuletti NA, Roig M, Karatzanos E, Nanas S (2013) Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med. doi:10.1186/1741-7015-1111-1137 PubMedCentralPubMedGoogle Scholar
  8. 8.
    Calvo-Ayala E, Khan BA, Farber MO, Ely E, Boustani MA (2013) Interventions to improve the physical function of ICU survivors: a systematic review. Chest 144:1469–1480CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Sossdorf M, Fischer J, Meyer S, Dahlke K, Wissuwa B, Seidel C, Schrepper A, Bockmeyer C, Lupp A, Neugebauer S, Schmerler D, Rodel J, Claus R, Otto G (2013) Physical exercise induces specific adaptations resulting in reduced organ injury and mortality during severe polymicrobial sepsis. Crit Care Med 41:E246–E255CrossRefPubMedGoogle Scholar
  10. 10.
    de Araujo CC, Silva JD, Samary CS, Guimaraes IH, Marques PS, Oliveira GP, do Carmo LG, Goldenberg RC, Bakker-Abreu I, Diaz Bl, Rocha NN, Capelozzi Vl, Pelosi P, Rocco PR (2012) Regular and moderate exercise before experimental sepsis reduces the risk of lung and distal organ injury. J Appl Physiol 112:1206–1214CrossRefPubMedGoogle Scholar
  11. 11.
    Coelho CW, Jannig PR, Souza AB, Fronza HJ, Westphal GA, Petronilho F, Constantino L, Dal-Pizzol F, Ferreira GK, Streck EE, Silva E (2013) Exercise training prevents skeletal muscle damage in an experimental sepsis model. Clinics 68:107–114CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Sossdorf M, Otto GP, Menge K, Claus R, Losche W, Kabisch B, Kohl M, Smolenski UC, Schlattmann P, Reinhart K, Winning J (2013) Potential effect of physiotherapeutic treatment on mortality rate in patients with severe sepsis and septic shock: a retrospective cohort analysis. J Crit Care 28:954–958CrossRefPubMedGoogle Scholar
  13. 13.
    Kayambu G, Boots RJ, Paratz JD (2011) Early rehabilitation in sepsis: a prospective randomised controlled trial investigating functional and physiological outcomes : the i-PERFORM trial (protocol article). BMC Anesthesiol. doi:10.1186/1471-2253-1111-1121 PubMedCentralPubMedGoogle Scholar
  14. 14.
    Schulz KF, Altman DG, Moher D (2011) CONSORT 2010 statement:updated guidelines for reporting parallel group randomised trials. Int J Surg 9:672–677CrossRefPubMedGoogle Scholar
  15. 15.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT et al (2008) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 36:1394–1396CrossRefGoogle Scholar
  16. 16.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829CrossRefPubMedGoogle Scholar
  17. 17.
    Charlson ME, Pompe P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  18. 18.
    Vincent JLMR, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  19. 19.
    Van Dillen LR, Roach KE (1988) Reliability and validity of the acute care index of function for patients with neurologic impairment. Phys Ther 68:1098–1101PubMedGoogle Scholar
  20. 20.
    Contopoulos-Ioannidis DG, Karvouni A, Kouri I, Ioannidis JP (2009) Reporting and interpretation of SF-36 outcomes in randomised trials: systematic review. BMJ. doi:10.1136/bmj.a3006 PubMedCentralPubMedGoogle Scholar
  21. 21.
    Skinner EH, Berny S, Warrillow S, Denehy L (2009) Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc 11:110–115PubMedGoogle Scholar
  22. 22.
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Zaleski ID, Boussarsar M, Charles C, Renaud E, Mesrati F, Carlet J, Raphae JC, Outin H, Bastuji-Garin S (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859–2867CrossRefPubMedGoogle Scholar
  23. 23.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar
  24. 24.
    Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299CrossRefPubMedGoogle Scholar
  25. 25.
    Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA (2000) Long term health related quality of life in survivors of sepsis. Short form 36: a valid and reliable measure of health related quality of life. Crit Care Med 28:3599–3605CrossRefPubMedGoogle Scholar
  26. 26.
    Nordon-Craft A, Schenkman M, Edbrooke L, Malone D, Moss M, Denehy L (2014) The physical function intensive care test: implementation in survivors of critical illness. Phys Ther 94:1499–1507CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Roach KE, Ally D, Finnerty B, Watkins D, Litwin BA, Janz-Hoover B, Watson T, Curtis KA (1998) The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower extremity orthopaedic problems. Phys Ther 78:19–24PubMedGoogle Scholar
  28. 28.
    Brunello AG, Haenggi M, Wigger O, Porta F, Takala J, Jakob SM (2010) Usefulness of a clinical diagnosis of ICU-acquired paresis to predict outcome in patients with SIRS and acute respiratory failure. Intensive Care Med 36:66–74CrossRefPubMedGoogle Scholar
  29. 29.
    Burtin C, Langer D, Troosters T, Hermans G, Decramer M (2009) Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 37:2499–2505CrossRefPubMedGoogle Scholar
  30. 30.
    Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, Mccallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated critically ill patients : a randomised controlled trial. Lancet 373:1874–1882CrossRefPubMedGoogle Scholar
  31. 31.
    Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, Gough K, Hoorn SV, Morris ME, Berney S (2013) Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months follow up. Crit Care. doi:10.1186/cc12835 PubMedCentralPubMedGoogle Scholar
  32. 32.
    Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG, Graves AJ, Shintani A, Murphy E, Work B, Pun BT, Boehm L, Gill TM, Dittus RS, Jackson JC (2014) Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med 40:370–379CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Poulsen JB, Moller K, Jensen CV, Weisdorf S, Kehlet H, Perner A (2011) Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Crit Care Med 39:456–461CrossRefPubMedGoogle Scholar
  34. 34.
    Rodriguez PO, Setten M, Maskin LP, Bonelli I, Vidomlansky SR, Attie S, Sl Frosiani, Kozima S, Valentini R (2012) Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care 27:311–318CrossRefGoogle Scholar
  35. 35.
    Llano-Diez M, Renaud G, Andersson M, Marrero H, Cacciani N, Engquist H, Corpeno R, Artemenko K, Bergquist J, Larsson L (2012) Mechanisms underlying ICU muscle wasting and effects of passive mechanical loading. Crit Care. doi:10.1186/cc11841 PubMedCentralPubMedGoogle Scholar
  36. 36.
    Renaud G, Llano-Diez M, Ravara B, Gorza L, Feng HZ, Jin JP, Cacciani N, Gustafson AM, Ochala J, Corpeno R, Li M, Hedstrom Y, Ford GC, Nair KS, Larsson L (2013) Sparing of muscle mass and function by passive loading in an experimental intensive care unit model. J Physiol 1:1385–1402CrossRefGoogle Scholar
  37. 37.
    Sharma R, Anker S (2002) Cytokines, apoptosis and cachexia: the potential for TNF antagonism. Int J Cardiol 85:161–171CrossRefPubMedGoogle Scholar
  38. 38.
    Sandi M (2002) Apoptotic signaling in skeletal muscle fibres during atrophy. Curr Opin Clin Nutr Metab Care 5:249–253CrossRefGoogle Scholar
  39. 39.
    Haddad F, Zaldivar F, Cooper D, Adams GR (2005) IL-6-induced skeletal muscle atrophy. J Appl Physiol 98:911–917CrossRefPubMedGoogle Scholar
  40. 40.
    Dupont-Versteegden EE (2006) Apoptosis in skeletal muscle and its relevance to atrophy. World J Gastroenterol 12:7463–7466PubMedCentralPubMedGoogle Scholar
  41. 41.
    Bonaldo P, Sandri M (2013) Cellular and molecular mechanisms of muscle atrophy. Dis Model Mech 6:25–39CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, Hopkinson NS, Phadke R, Dew T, Sidhu PS, Velloso C, Seymour J, Agley CC, Selby A, Limb M, Edwards LM, Smith K, Rowlerson A, Rennie MJ, Moxham J et al (2013) Acute skeletal muscle wasting in critical illness. JAMA 310:1591–1600CrossRefPubMedGoogle Scholar
  43. 43.
    Oberholzer A, Oberholzer C, Moldawer LL (2002) IL-10: a complex role in the pathogenesis of sepsis syndromes and its potential as an anti-inflammatory drug. Crit Care Med 30:S58–S63CrossRefGoogle Scholar
  44. 44.
    Schmidt M, Zogheib E, Roze H, Repesse X, Lebreton G, Luyt CE, Trouillet JL, Brechot N, Nieszkowska A, Dupont H, Ouattara A, Leprince P, Chastre J, Combes A (2013) The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39:1704–1713CrossRefPubMedGoogle Scholar
  45. 45.
    Rauch A, Cieza A, Stucki G (2008) How to apply the international classification of functioning, disability and health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med 44:329–342PubMedGoogle Scholar
  46. 46.
    Lisa JB, Kate F, Lara E, Selina MP, Rachel C, Thomas R, Susan CB, Linda D (2014) Low physical activity levels and poorer muscle strength are associated with reduced physical function at intensive care unit discharge: an observational study. In: C44 critical illness predictors and outcomes. American Thoracic Society 2014 International Conference, May 16-21, 2014, San Diego, A4543–A4543. doi:10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A4543
  47. 47.
    Baldwin CE, Bersten AD (2014) Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated. Phys Ther 94:68–82CrossRefPubMedGoogle Scholar
  48. 48.
    Huang CH, Martin AD, Davenport PW (2003) Effect of inspiratory muscle strength training on inspiratory motor drive and RREP early peak components. J Appl Physiol 94:462–468CrossRefPubMedGoogle Scholar
  49. 49.
    Denehy L, de Morton NA, Skinner EH, Edbrooke L, Haines K, Warrillow S, Berney S (2013) A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther 93:1636–1645CrossRefPubMedGoogle Scholar
  50. 50.
    Merom D, Phongsavan P, Wagner R, Chey T, Marnane C, Steel Z, Silove D, Bauman A (2008) Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders—a pilot group randomized trial. J Anxiety Disord 22:959–968CrossRefPubMedGoogle Scholar
  51. 51.
    Broman-Fulks JJ, Storey K (2008) Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety Stress Coping 21:117–128CrossRefPubMedGoogle Scholar
  52. 52.
    Herring MP, Ml Jacob, Suveg C, Dishman R, O’Connor PJ (2012) Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom 81:21–28CrossRefPubMedGoogle Scholar
  53. 53.
    Hopkins RO (2014) Early cognitive and physical rehabilitation: one step towards improving post-critical illness outcomes. Intensive Care Med 40:442–444CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Geetha Kayambu
    • 1
  • Robert Boots
    • 1
    • 2
  • Jennifer Paratz
    • 1
    • 3
  1. 1.School of Medicine, Burns, Trauma and Critical Care Research CentreThe Royal Brisbane and Women’s Hospital, The University of QueenslandBrisbaneAustralia
  2. 2.Department of Intensive Care MedicineBurns Trauma and Critical Care Research Centre, The Royal Brisbane and Women’s HospitalBrisbaneAustralia
  3. 3.Griffith UniversityBrisbaneAustralia

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