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Abstract
BACKGROUND: Early mobilization during critical illness is safe and has beneficial effects on functional outcomes. However, its impact on pulmonary function has not been thoroughly explored. We hypothesized that a sitting position out of bed coupled with exercise could result in an improvement in oxygenation and lung aeration.
METHODS: The study was conducted on a cohort of adult subjects within a week of their admission to an ICU. Subjects were transferred to a chair and undertook a 15-min session of exercise, either active or passive. Subjects in the control group were only transferred to a chair. Electrical impedance tomography, a reliable bedside technique monitoring regional lung aeration and the distribution of ventilation, was continuously performed, and blood gases were assessed at baseline and 20 min post-exercise.
RESULTS: The cohort included 40 subjects, 17 of whom were mechanically ventilated and 23 spontaneously breathing. The control group for each modality consisted of 5 mechanically ventilated or 5 spontaneously breathing subjects. Mild hypoxemia was present in 45% of the spontaneously breathing cohort, whereas the mechanically ventilated subjects demonstrated moderate (50%) or severe (12%) hypoxemia. Compared with the control group, early mobilization induced a significant increase in lung aeration. In mechanically ventilated subjects, lung aeration increased, especially in the anterior lung regions (mean impedance [95% CI]: T1 (baseline in bed) = 1,265 [691–1,839]; T2 (chair sitting) = 2,003 [1,042–2,963]; T3 (exercise) = 1,619 [810 2,427]; T4 (post exercise in chair) = 2,320 [1,186–3,455]). In spontaneously breathing subjects, lung aeration increased mainly in the posterior lung regions (mean impedance [95% CI]: T1 = 380 [124–637]; T2 = 655 [226–1,084]; T3 = 621 [335–906]; T4 = 600 [340–860]). 
increased, especially in subjects with lower 
at baseline (< 200) (133 ± 31 to 158 ± 48, P = .041).
CONCLUSIONS: For critically ill subjects, a sitting position and exercise increased lung aeration and were associated with an improvement in 
in the more severely hypoxemic subjects.
- early mobilization
- exercise therapy
- critically ill
- alveolar recruitment
- oxygenation
- electrical impedance tomography
Footnotes
- Correspondence: Cheryl E Hickmann PT PhD, Université catholique de Louvain (UCL), Cliniques universitaires Saint Luc, Department of Critical Care Medicine, 10, Avenue Hippocrate, B-1200 Brussels, Belgium. E-mail: cheryl.hickmann{at}uclouvain.be
Dr Hickmann and Ms Montecinos-Munoz are co-first authors.
Ms Montecinos-Munoz presented a version of this paper at the 6th European Conference on Weaning and Rehabilitation in Critically Ill Patients, held November 9–11, 2018, in Leuven, Belgium. Dr Hickmann presented a version of this paper at the annual meeting of the Belgian Society of Intensive Care Medicine, held June 14, 2019, in Brussels, Belgium.
Supplementary material related to this paper is available at http://www.rcjournal.com.
The authors have disclosed no conflicts of interest.
- Copyright © 2021 by Daedalus Enterprises
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