Cytokines in chronically critically ill patients after activity and rest
ABSTRACT Inflammation, a common problem for patients in the intensive care unit (ICU), frequently is associated with serious and prolonged critical illnesses. To date, no study has examined whether physical activity influences inflammatory factors in critically ill adults. The objectives of this study were to (a) examine the relationships between type and duration of physical activity and serum levels of interleukin 6 (IL-6), a proinflammatory cytokine; IL-10, an anti-inflammatory cytokine; and their ratio and (b) determine if there are associations between cytokines or their ratio and activity or outcomes. This descriptive feasibility study investigated the approaches to measuring levels of physical activity and its relationship to serum levels of IL-6 and IL-10 and the ratio between them in patients with prolonged mechanical ventilation during periods of activity and rest. Measurements included serum IL-6 and IL-10 levels, direct observation and actigraphy, and prospective chart review. Ten critically ill patients who were mechanically ventilated for an average of 10 days in a large, urban, teaching hospital were enrolled. The average ratio of IL-6 to IL-10 improved after an average of 14.7 min of passive physical activity, typically multiple in-bed turns associated with hygiene. IL-6, IL-10, and their ratio were not associated with patient outcomes of weaning success or length of stay. High levels of IL-6 were associated with mortality. Cytokine balance may be improved by low levels of activity among patients with prolonged critical illness. The pattern of cytokines produced after activity may improve patients' recovery from prolonged critical illness and mechanical ventilation.
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ABSTRACT: Bed rest is a commonly prescribed activity restriction among patients in the ICU. Although bed rest may promote rest, recovery and safety, inactivity related to bed rest also may lead to complications and adverse outcomes. The biological mechanisms that lead to immediate and long-term sequelae from bed rest have not been elucidated. It may be the inflammatory factors common to critical illness combined with bed rest lead to a positive feedback loop, contributing to inflammatory disequilibrium. This disequilibrium has a profound affect on muscles. Muscle decay has serious and long-term adverse outcomes on survivors of critical illness. Mobility therapy may improve inflammatory disequilibrium and preserve muscles, leading to improved functional outcome. Investigations in the laboratory, in healthy people and among patients with systemic inflammatory disease, suggest that activity does not exacerbate inflammation. Clinically, exercise is beneficial to patients with various chronic inflammatory diseases. Further study is needed to best understand the role, duration, and frequency of activity in promoting recovery for critically ill patients.Critical Care Clinics 02/2007; 23(1):21-34. DOI:10.1016/j.ccc.2006.11.002 · 2.50 Impact Factor
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ABSTRACT: PurposeTo study how the health-related quality of life (HRQOL) of survivors of penetrating trunk trauma (PTT) changes from pre-morbid status to 6months after hospital discharge and to determine differences in the HRQOL between subjects ventilated for short and prolonged periods of time. To determine how the HRQOL of PTT survivors compares with that of a healthy control group in order to identify limitations imposed by critical illness. MethodsRetrospective and observational prospective assessment of the quality of life (QoL) of PTT survivors with the Medical Outcomes Short Form-36 (SF-36) UK English version questionnaire. Cross-sectional assessment of the QoL of a healthy control group with the SF-36. ResultsThe physical component summary (PCS) score was significantly reduced for the short mechanical ventilation (MV) group (n=13) at 1 and 3months compared to pre-admission status (p=0.00, respectively). The mental component summary (MCS) score was significantly reduced at 1, 3 and 6months (p=0.00, respectively). The PCS and MCS were significantly reduced for the long MV group (n=29) at all three assessments compared to the pre-admission HRQOL (p=0.00–0.01). The short MV group reported HRQOL comparable to that of the healthy group (n=40) at 6months after discharge. The long MV group had a significant reduction in the PCS at 1, 3 and 6months compared to the healthy group (p=0.00, respectively). The long MV group had significantly reduced PCS at 3 and 6months compared to the short MV group (p=0.01 and 0.00, respectively). ConclusionsSubjects who had higher morbidity and prolonged MV suffered from reduced HRQOL related to physical health for up to 6months after discharge. KeywordsHealth-related quality of life–SF-36–Trauma–Morbidity–Prolonged ventilationEuropean Journal of Trauma and Emergency Surgery 08/2011; 37(4):419-426. DOI:10.1007/s00068-010-0071-4 · 0.38 Impact Factor
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ABSTRACT: The Task Force reviewed and discussed the available literature on the effectiveness of physiotherapy for acute and chronic critically ill adult patients. Evidence from randomized controlled trials or meta-analyses was limited and most of the recommendations were level C (evidence from uncontrolled or nonrandomized trials, or from observational studies) and D (expert opinion). However, the following evidence-based targets for physiotherapy were identified: deconditioning, impaired airway clearance, atelectasis, intubation avoidance, and weaning failure. Discrepancies and lack of data on the efficacy of physiotherapy in clinical trials support the need to identify guidelines for physiotherapy assessments, in particular to identify patient characteristics that enable treatments to be prescribed and modified on an individual basis. There is a need to standardize pathways for clinical decision-making and education, to define the professional profile of physiotherapists, and increase the awareness of the benefits of prevention and treatment of immobility and deconditioning for critically ill adult patients.Intensive Care Medicine 08/2008; 34(7):1188-99. DOI:10.1007/s00134-008-1026-7 · 5.54 Impact Factor