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Research ArticleOriginal Research

Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects

Cheryl E Hickmann, Natalia R Montecinos-Munoz, Diego Castanares-Zapatero, Ricardo S Arriagada-Garrido, Ursula Jeria-Blanco, Timour Gizzatullin, Jean Roeseler, Jonathan Dugernier, Xavier Wittebole and Pierre-François Laterre
Respiratory Care February 2021, 66 (2) 253-262; DOI: https://doi.org/10.4187/respcare.07487
Cheryl E Hickmann
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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  • For correspondence: [email protected]
Natalia R Montecinos-Munoz
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Diego Castanares-Zapatero
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Ricardo S Arriagada-Garrido
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Ursula Jeria-Blanco
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Timour Gizzatullin
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Jean Roeseler
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Jonathan Dugernier
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Xavier Wittebole
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Pierre-François Laterre
Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
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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]). Embedded Image increased, especially in subjects with lower Embedded Image 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 Embedded Image 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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Respiratory Care: 66 (2)
Respiratory Care
Vol. 66, Issue 2
1 Feb 2021
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Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects
Cheryl E Hickmann, Natalia R Montecinos-Munoz, Diego Castanares-Zapatero, Ricardo S Arriagada-Garrido, Ursula Jeria-Blanco, Timour Gizzatullin, Jean Roeseler, Jonathan Dugernier, Xavier Wittebole, Pierre-François Laterre
Respiratory Care Feb 2021, 66 (2) 253-262; DOI: 10.4187/respcare.07487

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Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects
Cheryl E Hickmann, Natalia R Montecinos-Munoz, Diego Castanares-Zapatero, Ricardo S Arriagada-Garrido, Ursula Jeria-Blanco, Timour Gizzatullin, Jean Roeseler, Jonathan Dugernier, Xavier Wittebole, Pierre-François Laterre
Respiratory Care Feb 2021, 66 (2) 253-262; DOI: 10.4187/respcare.07487
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Keywords

  • early mobilization
  • exercise therapy
  • critically ill
  • alveolar recruitment
  • oxygenation
  • electrical impedance tomography

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