Effect of a passive mobilization session with restriction of blood flow on cardiovascular, respiratory and disorders of organs of critical patients

Abstract

Atrophy and muscle weakness are findings commonly observed in critically ill patients, which are associated with organ dysfunction. Passive mobilization (PM) is a therapeutic strategy used for comatose patients, however, there is no evidence that PM promotes prevention of atrophy and muscle weakness in the ICU. On the other hand, blood flow restriction (RFS) has been used as a strategy to prevent atrophy and muscle weakness from disuse in non-hospital rehabilitation. In intensive care, only one study applied RFS associated with PM recently, with a result of reduced muscle atrophy. Abnormal cardiovascular responses, such as excessive blood pressure and heart rate increases, have been reported in discussions about the safety of using RFS in individuals at high cardiovascular risk. In addition, the respiratory and organ dysfunction responses of patients with low mobility remain unknown in critical care. Objectives: To analyze the effect of a PM session with RFS on cardiovascular, respiratory and organ dysfunction responses in critically ill patients. Methods: Seven patients within 18 hours of coma in the ICU will be evaluated at baseline (T0) for sample characterization and randomly distributed to perform one of the two training protocols: PM or control group and PM associated with flow restriction blood flow (RFSp) in the first training session (T1) and, subsequently, to perform the other protocol in the second training session (T3), following a crossover experimental design. T1 and T3 will be monitored to measure acute cardiovascular and respiratory responses by analyzing pulse wave (AOP) and transthoracic electrical bioimpedance and respiratory vital signs, respectively. Cardiovascular and respiratory system responses after muscle training will be assessed using vital signs and laboratory test results collected 6 hours after T1 (T2) and 6 hours after T3 (T4). At the same time, the degree of organ dysfunction will be assessed by the Sequential Organ Failure Assessment (SOFA) score. For statistical analysis, the Shapiro Wilk test and mixed model analysis will be used, as well as P <0.05.