267 research outputs found
A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients
No full textEarly mobilisation of critically ill patients is safe and beneficial, but the metabolic cost of exercise remains unquantified. This study compared the acute exercise response in critically ill participants during passive and active sitting. Method: We conducted a prospective, randomised, cross-over study, in ventilated patients receiving rehabilitative physiotherapy. Ten participants completed a passive chair transfer, or a sit on the edge of the bed, followed by the alternate exercise activity on the consecutive day. The primary outcome measure was oxygen consumption. Results: In comparison to resting supine, a passive chair transfer elicited no change in oxygen consumption, carbon dioxide production or minute ventilation; but mean arterial pressure (91.86 mmHg (95% CI 84.61 to 99.10) to 101.23 mmHg (95% CI 93.35 to 109.11) (p = 0.002)) and heart rate (89.13 bpm (95% CI 77.14 to 101.13) to 97.21 bpm (95% CI 81.22 to 113.20) (p = 0.008)) increased. Sitting on the edge of the bed resulted in significant increases in oxygen consumption (262.33 ml/min (95% CI 201.97 to 322.70) to 353.02 ml/min (95% CI 303.50 to 402.55), p = 0.002), carbon dioxide production (171.93 ml/min (95% CI 131.87 to 211.98) to 206.23 ml/min (95% CI 151.03 to 261.43), p = 0.026), minute ventilation (9.97 l/min (95% CI 7.30 to 12.65) to 12.82 l/min (95% CI 10.29 to 15.36), p < 0.001), mean arterial pressure (86.81 mmHg (95% CI 77.48 to 96.14) to 95.59 mmHg (95% CI 88.62 to 102.56), p = 0.034) and heart rate (87.60 bpm (95% CI 73.64 to 101.56) to 94.91 bpm (95% CI 79.57 to 110.25), p = 0.007). When comparing the 2 activities, sitting on the edge of the bed elicited a significantly larger increase in oxygen consumption (90.69 ml/min (95% CI 44.04 to 137.34) vs 14.43 ml/min (95% CI -27.28 to 56.14), p = 0.007) and minute ventilation (2.85 l/min (95% CI 1.70 to 3.99) vs 0.74 l/min (95% CI -0.92 to 1.56), p = 0.012). Conclusion: Sitting on the edge of the bed is a more metabolically demanding activity than a passive chair transfer in critically ill patients.</p
The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis
No full textIntroduction: Triage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to assist in the triage of critical care admissions and discharges during an influenza outbreak in the UK. There are data to suggest that had it been used in the recent H1N1 pandemic it may have led to inappropriate limitation of therapy if surge capacity had been overwhelmed.Methods: We retrospectively reviewed the performance of the Simple Triage Scoring System (STSS) as an indicator of the utilization of hospital resources in adult patients with confirmed H1N1 admitted to a university teaching hospital. Our aim was to compare it against the staged initial SOFA score process with regards to mortality, need for intensive care admission and requirement for mechanical ventilation and assess its validity.Results: Over an 8 month period, 62 patients with confirmed H1N1 were admitted. Forty (65%) had documented comorbidities and 27 (44%) had pneumonic changes on their admission CXR. Nineteen (31%) were admitted to the intensive care unit where 5 (26%) required mechanical ventilation (MV). There were 3 deaths. The STSS group categorization demonstrated a better discriminating accuracy in predicting critical care resource usage with a receiver operating characteristic area under the curve (95% confidence interval) for ICU admission of 0.88 (0.78-0.98) and need for MV of 0.91 (0.83-0.99). This compared to the staged SOFA score of 0.77 (0.65-0.89) and 0.87 (0.72-1.00) respectively. Low mortality rates limited analysis on survival predictions.Conclusions: The STSS accurately risk stratified patients in this cohort according to their risk of death and predicted the likelihood of admission to critical care and the requirement for MV. Its single point in time, accuracy and easily collected component variables commend it as an alternative reproducible system to facilitate the triage and treatment of patients in any future influenza pandemic.</p
Arterial blood gas analysis and lactate
No full textIt has long been recognized that a disturbance of the homeostatic mechanisms controlling the body's acid-base balance is associated with an increased risk of organ dysfunction and death in the critically ill patient. Despite acid-base imbalance being an integral aspect of ongoing pathologic processes in a large number critically ill patients, the importance of understanding the fundamental principals behind the physiology has been largely ignored. Measurement of the standard bicarbonate and base excess have been used for decades as indicators of metabolic acid-base disturbances. These techniques, however, are dependent upon normal electrolyte, water, and albumin content in the patients. Needless to say, these conditions are rarely met in the critically ill patient, and estimations of the degree of metabolic disturbance may be, therefore, inaccurate. The anion gap has been proposed to give a better indication as to the origin of the metabolic upset. However, this measurement is still reliant upon normal albumin and PCO2 levels. Serum lactate levels have been used as a prognostic marker in the critically ill with some degree of success, but the metabolism of lactate is complex and incompletely understood. The belief that lactates can be accurately used as a stand-alone marker of outcome and mortality is thus naive. More recently, quantitative studies on acid-base imbalance have shown that three independent variables determine the hydrogen and bicarbonate ion concentrations in complex solutions such as plasma. These principles have been developed such that estimates of metabolic derangement can be made in the critically ill without making incorrect assumptions about albumin and free water concentrations. These newer techniques may give improved insights as to the origins to the acid-base disturbances seen in the critically ill and thus aid therapy. (C) 2000 Lippincott Williams and Wilkins, Inc.</p
An observational feasibility study - does early limb ergometry affect oxygen delivery and uptake in intubated critically ill patients – a comparison of two assessment methods
No full textBackground: early rehabilitation can reduce ventilation duration and improve functional outcomes in critically ill patients. Upper limb strength is associated with ventilator weaning. Passive muscle loading may preserve muscle fibre function, help recover peripheral muscle strength and improve longer term, post-hospital discharge function capacity. The physiological effects of initiating rehabilitation soon after physiological stabilisation of these patients can be concerning for clinicians. This study investigated the feasibility of measuring metabolic demand and the safety and feasibility of early upper limb passive ergometry. An additional comparison of results, achieved from simultaneous application of the methods, is reported. Methods: this was an observational feasibility study undertaken in an acute teaching hospital’s General Intensive Care Unit in the United Kingdom. Twelve haemodynamically stable, mechanically ventilated patients underwent 30 minutes of arm ergometry. Cardiovascular and respiratory parameters were monitored. A Friedman test identified changes in physiological parameters. A metabolic cart was attached to the ventilator to measure oxygen uptake. Oxygen uptake was concurrently calculated by the reverse Fick method, utilising cardiac output from the LiDCO™ and paired mixed venous and arterial samples. A comparison of the two methods was made. Data collection began 10 minutes before ergometry and continued to recovery. Paired mixed venous and arterial samples were taken every 10 minutes. Results: twelve patients were studied; 9 male, median age 55 years, range (27–82), median APACHE score 18.5, range (7–31), median fraction inspired oxygen 42.5%, range (28–60). Eight patients were receiving noradrenaline. Mean dose was 0.07 mcg/kg/min, range (0.01–0.15). Early ergometry was well tolerated. There were no clinically significant changes in respiratory, haemodynamic or metabolic variables pre ergometry to end recovery. There was no significant difference between the two methods of calculating VO<jats:sub/>2 (p = 0.70). Conclusions: we report the feasibility of using the reverse Fick method and indirect calorimetry to measure metabolic demand during early physical rehabilitation of critically ill patients. More research is needed to ascertain the most reliable method. Minimal change in metabolic demand supports the safety and feasibility of upper limb ergometry. These results will inform future study designs for further research into exercise response in critically ill patients. Trial Registration Clinicaltrials.gov No. NCT04383171. Registered on 06 May 2020 - Retrospectively registered. http://www.clinicaltrials.gov
Immunonutrition for acute respiratory distress syndrome (ARDS) in adults
No full textThis is the protocol for a review and there is no abstract. The objectives are as follows: To systematically review and critically appraise the available evidence on the effects of immunonutrition compared to a standard non-immunonutrition formula feed on mechanically ventilated, adult patients (aged 18 years or older) with acute respiratory distress syndrome (ARDS).</p
Portrait of Dymphna Cusack, author [picture]
No full textCondition: Good.; Part of collection: Ion Idriess glass plate negative collection.; Title from signature on image.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn3299415. "My love, Dymphna Cusack 1954"--signature on image
Parallels between astronauts and terrestrial patients – taking physiotherapy rehabilitation “To infinity and beyond”
No full textExposure to the microgravity environment induces physiological changes in the cardiovascular, musculoskeletal and sensorimotor systems in healthy astronauts. As space agencies prepare for extended duration missions, it is difficult to predict the extent of the effects that prolonged exposure to microgravity will have on astronauts. Prolonged bed rest is a model used by space agencies to simulate the effects of spaceflight on the human body, and bed rest studies have provided some insights into the effects of immobilisation and inactivity. Whilst microgravity exposure is confined to a relatively small population, on return to Earth, the physiological changes seen in astronauts parallel many changes routinely seen by physiotherapists on Earth in people with low back pain (LBP), muscle wasting diseases, exposure to prolonged bed rest, elite athletes and critically ill patients in intensive care. The medical operations team at the European Space Agency are currently involved in preparing astronauts for spaceflight, advising on exercises whilst astronauts are on the International Space Station, and reconditioning astronauts following their return. There are a number of parallels between this role and contemporary roles performed by physiotherapists working with elite athletes and muscle wasting conditions. This clinical commentary will draw parallels between changes which occur to the neuromuscular system in the absence of gravity and conditions which occur on Earth. Implications for physiotherapy management of astronauts and terrestrial patients will be discussed
Patient and family experience of physical rehabilitation on the intensive care unit: a qualitative exploration
No full textObjectives: to explore the experience of physical rehabilitation in the intensive care unit (ICU), from the perspective of patients and relatives.Design: exploratory, qualitative study.Participants: five former ICU patients and five family members of former ICU patients recruited from ICU support groups across the UK.Interventions: semi-structured interviews.Main outcome measures: participants’ experiences of physical rehabilitation in the ICU. Data were analysed using an iterative thematic approach.Results: four main themes were identified: Trust and Rapport, Necessity (of treatment), Psychological Benefit, and Goal Setting: Whose goal is it anyway? Despite a lack of enjoyment, patients tend to comply with physical rehabilitation, due in part to a positive patient–therapist relationship. There was agreement across participants that physical rehabilitation should be started as soon as possible after admission to ICU and exhaustion was highlighted as the biggest challenge to participation. In addition to aiding physical recovery, physical rehabilitation in the ICU may also provide psychological support for both patients and relatives. Finally, participants described a desire for therapists to direct goal setting in the early stages of recovery as they felt unable to engage in the process due to other priorities.Conclusions: the experience of physical rehabilitation on ICU may be influenced by key aspects of person-centred care. This study suggests that patients and relatives are keen for physical rehabilitation to start as soon as possible, which is a crucial new finding to support the practice of early rehabilitation in the ICU
Abnormal liver phosphatidylcholine synthesis revealed in patients with acute respiratory distress syndrome
No full textAcute respiratory distress syndrome (ARDS) is associated with a severe pro-inflammatory response; although decreased plasma cholesterol concentration has been linked to systemic inflammation, any association of phospholipid metabolic pathways with ARDS has not been characterized. Plasma phosphatidylcholine (PC), the major phospholipid of circulating lipoproteins, is synthesized in human liver by two biologically diverse pathways: the CDP:choline and phosphatidylethanolamine-N-methyltransferase (PEMT) pathways. Here, we used electrospray ionization–MS/MS both to characterize plasma PC compositions and to quantify metabolic fluxes of both pathways using stable isotopes in patients with severe ARDS and in healthy controls. Direct incorporation of methyl-D9-choline estimated CDP:choline pathway flux, while PEMT flux was determined from incorporations of one and two methyl-D3 groups derived from methyl-D9-choline. Results of MS/MS analysis showed significant alterations in plasma PC composition in patients with ARDS versus healthy controls. In particular, the increased overall methyl-D9-PC enrichment and—most important—the much lower methyl-D3-PC and methyl-D6-PC enrichments—suggest increased flux through the CDP:choline pathway and reduced flux through the PEMT pathway in ARDS. To our knowledge, this study is the first to demonstrate significant plasma PC molecular compositional changes combined with associated alterations in the dynamics of PC synthetic pathways in patients with ARDS
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