Cytokines in Chronically Critically Ill Patients After Activity and Rest
Case Western Reserve University, Cleveland, Ohio, United States Biological Research for Nursing
(Impact Factor: 1.43).
05/2007; 8(4):261-71. DOI: 10.1177/1099800406298168
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.
Available from: Robert Boots
- "A number of studies [20-22] in healthy and other diseased populations; such as in chronic heart failure, have shown that aerobic and resisted exercise alters pro-inflammatory cytokines specifically decreasing IL-6 and TNF-α and increasing IL-10. Simple physical exercises such as repetitive passive muscle stretches have been shown to decrease pro-inflammatory cytokine (IL-6), increase anti-inflammatory cytokine (IL-10) and improve the IL-10/TNF-α ratio in chronic critically ill patients . The use of electrical muscle stimulation on major muscle groups has been shown to attenuate the production of TNF-α . "
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ABSTRACT: Patients with sepsis syndromes in comparison to general intensive care patients can have worse outcomes for physical function, quality of life and survival. Early intensive care rehabilitation can improve the outcome in general Intensive Care Unit (ICU) patients, however no investigations have specifically looked at patients with sepsis syndromes. The 'i-PERFORM Trial' will investigate if early targeted rehabilitation is both safe and effective in patients with sepsis syndromes admitted to ICU.
A single-centred blinded randomized controlled trial will be conducted in Brisbane, Australia. Participants (n = 252) will include those ≥ 18 years, mechanically ventilated for ≥ 48 hours and diagnosed with a sepsis syndrome. Participants will be randomised to an intervention arm which will undergo an early targeted rehabilitation program according to the level of arousal, strength and cardiovascular stability and a control group which will receive normal care.The primary outcome measures will be physical function tests on discharge from ICU (The Acute Care Index of Function and The Physical Function ICU Test). Health-related quality of life will be measured using the Short Form-36 and the psychological component will be tested using The Hospital Anxiety and Depression Scale. Secondary measures will include inflammatory biomarkers; Interleukin-6, Interleukin-10 and Tumour Necrosis Factor-α, peripheral blood mitochondrial DNA content and lactate, fat free muscle mass, tissue oxygenation and microcirculatory flow.
The 'i-PERFORM Trial' will determine whether early rehabilitation for patients with sepsis is effective at improving patient outcomes with functional and physiological parameters reflecting long and short-term effects of early exercise and the safety in its application in critical illness.
Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000808044.
Available from: Chris Winkelman
- "One pilot study examined the changes of plasma cytokines in hemodynamically stable patients who experienced an average of 10 days of mechanical ventilation. Data suggested that 20 minutes of sustained activity in bed (repositioning and range of motion activities) did not alter plasma levels of IL-6 or IL-10 . This sample was small (n ¼ 10) and focused on chronically , critically ill adults, so findings may not be applicable to all ICU adults. "
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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.
Available from: Witness Mudzi
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To study how the health-related quality of life (HRQOL) of survivors of penetrating trunk trauma (PTT) changes from pre-morbid status to 6 months 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.
Retrospective 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.
The physical component summary (PCS) score was significantly reduced for the short mechanical ventilation (MV) group (n = 13) at 1 and 3 months compared to pre-admission status (p = 0.00, respectively). The mental component summary (MCS) score was significantly reduced at 1, 3 and 6 months (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 6 months after discharge. The long MV group had a significant reduction in the PCS at 1, 3 and 6 months compared to the healthy group (p = 0.00, respectively). The long MV group had significantly reduced PCS at 3 and 6 months compared to the short MV group (p = 0.01 and 0.00, respectively).
Subjects who had higher morbidity and prolonged MV suffered from reduced HRQOL related to physical health for up to 6 months after discharge.
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