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The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients

Early mobilization has become an important aspect of treatment in intensive care medicine, especially in patients with acute pulmonary dysfunction. As its effects on regional lung physiology have not been fully explored, we conceived a prospective observational study (Registration number: DRKS000230...

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Autores principales: Eimer, Christine, Freier, Katharina, Weiler, Norbert, Frerichs, Inéz, Becher, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488288/
https://www.ncbi.nlm.nih.gov/pubmed/34616313
http://dx.doi.org/10.3389/fphys.2021.749542
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author Eimer, Christine
Freier, Katharina
Weiler, Norbert
Frerichs, Inéz
Becher, Tobias
author_facet Eimer, Christine
Freier, Katharina
Weiler, Norbert
Frerichs, Inéz
Becher, Tobias
author_sort Eimer, Christine
collection PubMed
description Early mobilization has become an important aspect of treatment in intensive care medicine, especially in patients with acute pulmonary dysfunction. As its effects on regional lung physiology have not been fully explored, we conceived a prospective observational study (Registration number: DRKS00023076) investigating regional lung function during a 15-min session of early mobilization physiotherapy with a 30-min follow-up period. The study was conducted on 20 spontaneously breathing adult patients with impaired pulmonary gas exchange receiving routine physical therapy during their intensive care unit stay. Electrical impedance tomography (EIT) was applied to continuously monitor ventilation distribution and changes in lung aeration during mobilization and physical therapy. Baseline data was recorded in the supine position, the subjects were then transferred into the seated and partly standing position for physical therapy. Afterward, patients were transferred back into the initial position and followed up with EIT for 30 min. EIT data were analyzed to assess changes in dorsal fraction of ventilation (%dorsal), end-expiratory lung impedance normalized to tidal variation (ΔEELI), center of ventilation (CoV) and global inhomogeneity index (GI index).Follow-up was completed in 19 patients. During exercise, patients exhibited a significant change in ventilation distribution in favor of dorsal lung regions, which did not persist during follow-up. An identical effect was shown by CoV. ΔEELI increased significantly during follow-up. In conclusion, mobilization led to more dorsal ventilation distribution, but this effect subsided after returning to initial position. End-expiratory lung impedance increased during follow-up indicating a slow increase in end-expiratory lung volume following physical therapy.
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spelling pubmed-84882882021-10-05 The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients Eimer, Christine Freier, Katharina Weiler, Norbert Frerichs, Inéz Becher, Tobias Front Physiol Physiology Early mobilization has become an important aspect of treatment in intensive care medicine, especially in patients with acute pulmonary dysfunction. As its effects on regional lung physiology have not been fully explored, we conceived a prospective observational study (Registration number: DRKS00023076) investigating regional lung function during a 15-min session of early mobilization physiotherapy with a 30-min follow-up period. The study was conducted on 20 spontaneously breathing adult patients with impaired pulmonary gas exchange receiving routine physical therapy during their intensive care unit stay. Electrical impedance tomography (EIT) was applied to continuously monitor ventilation distribution and changes in lung aeration during mobilization and physical therapy. Baseline data was recorded in the supine position, the subjects were then transferred into the seated and partly standing position for physical therapy. Afterward, patients were transferred back into the initial position and followed up with EIT for 30 min. EIT data were analyzed to assess changes in dorsal fraction of ventilation (%dorsal), end-expiratory lung impedance normalized to tidal variation (ΔEELI), center of ventilation (CoV) and global inhomogeneity index (GI index).Follow-up was completed in 19 patients. During exercise, patients exhibited a significant change in ventilation distribution in favor of dorsal lung regions, which did not persist during follow-up. An identical effect was shown by CoV. ΔEELI increased significantly during follow-up. In conclusion, mobilization led to more dorsal ventilation distribution, but this effect subsided after returning to initial position. End-expiratory lung impedance increased during follow-up indicating a slow increase in end-expiratory lung volume following physical therapy. Frontiers Media S.A. 2021-09-20 /pmc/articles/PMC8488288/ /pubmed/34616313 http://dx.doi.org/10.3389/fphys.2021.749542 Text en Copyright © 2021 Eimer, Freier, Weiler, Frerichs and Becher. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Eimer, Christine
Freier, Katharina
Weiler, Norbert
Frerichs, Inéz
Becher, Tobias
The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title_full The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title_fullStr The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title_full_unstemmed The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title_short The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients
title_sort effect of physical therapy on regional lung function in critically ill patients
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488288/
https://www.ncbi.nlm.nih.gov/pubmed/34616313
http://dx.doi.org/10.3389/fphys.2021.749542
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