The oxygen cost of rehabilitation interventions in mechanically ventilated patients: an observational study
Claire Black1, Micheal Grocott2, Mervyn Singer1
1University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; Bloomsbury Institute for Intensive Care Medicine, University College London, Cruciform Building, Gower Street, London WC1E 6BT, UK.
Objective:
Early rehabilitation is assumed to be a crucial intervention to facilitate weaning from mechanical ventilation in critically ill patients and to limit their long-term functional dependence. However, little is known about the physiological load imposed on patients during such interventions. Without the ability to quantify the exercise intensity of rehabilitation interventions it is impossible to establish a clear separation between usual care and intervention groups in randomised controlled trials. This may explain the lack of definitive benefit of rehabilitation in published trials. We sought to characterise the physiological load, measured as oxygen consumption (V˙O2), of the physical activities carried out during rehabilitation interventions in mechanically ventilated participants.
Design:
Observational study.
Setting:
Single centre medical-surgical university hospital ICU.
Participants:
26 mechanically ventilated participants ventilated >7 days, able to participate in a rehabilitation program.
Intervention:
Oxygen consumption (measured by the Medgraphics Ultima breath-by-breath gas exchange analysis system) and heart rate were measured continuously pre-, during and post-standard rehabilitation sessions.
Results:
52 sessions were recorded in 26 participants. There was considerable variation in the oxygen cost of the physical activities between participants. The recovery time for 1 in 4 rehabilitation sessions was longer than the rehabilitation activity time.
Conclusions:
Absolute exercise intensity in mechanically ventilated ICU participants, as measured by oxygen consumption, is not activity-dependent.
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