Effects of an integrative relaxation intervention on inflammatory and stress biomarkers in critically ill patients
CCCF ePoster library. Papathanassoglou E. 11/01/16; 150938; 59
Assoc. Prof. Elizabeth Papathanassoglou
Assoc. Prof. Elizabeth Papathanassoglou
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Topic: Clinical Trial

Effects of an integrative relaxation intervention on inflammatory and stress biomarkers in critically ill patients

Papathanassoglou E1, Hadjibalassi M2, Miltiadous P2, Karanikola M2
1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
2 Department of Nursing, Cyprus University of Technology, Limassol, Cyprus

Grant acknowledgements:
Cyprus University of Technology Faculty Research Grant


Introduction: Recent guidelines recommend exploring non-pharmacological approaches for addressing critically ill patients’ pain, anxiety and delirium. Preliminary evidence shows that relaxation approaches associate with improvements in critically ill patients’ pain, anxiety and length of stay. Nonetheless, underlying mechanisms and pertinent biomarkers have not been investigated.
Objectives: We hypothesized that the effects of a relaxation-inducing integrative intervention are associated with alterations in levels of stress neuropeptides and inflammatory mediators. We explored the effects of a multimodal integrative nursing intervention on serum levels of the neuropeptide Y (NPY), oxytocin (OCT), the inflammatory/ apoptotic marker fasL and High-mobility group box-1 (HMGB-1) in critically ill patients.
Methods: Pilot, single-blind randomized controlled trial with sixty ICU patients and repeated measurements. Participants were randomly allocated to an intervention and a control group. The intervention group received standard care plus integrative intervention once daily for up to 5 days. The control group received standard care only. The intervention consisted of presence, positive-touch massage, relaxation, guided imagery, and music listening (total duration 50 min) for up to 5 days while in the ICU or until discharge from the ICU. Inclusion criteria included: age ≥18, Glasgow Coma Scale ≥ 9, Richmond Agitation Sedation Scale (RASS) score: -3- +3. Outcome measures included pain ratings [numeric rating scale (NRS), critical-care pain observation tool (CPOT)], self-reported anxiety and relaxation (NRS), inflammatory markers (HMGB-1, fasL) and stress-neuropeptides (NPY, OCT). Caregivers and outcome assessors were blinded to treatment allocation. Biomarker levels were quantified by an enzyme-linked immunosorbent assay. Statistical analysis included analysis of covariance (ANCOVA), linear mixed models (LMM), t-test, and calculations of Cohen’s d for effect size and Spearman’s rho correlation coefficients for cross-sectional associations.
Results: At baseline, no statistically significant differences were noted with regard to participants’ demographics, diagnoses, clinical severity, pain, anxiety and medications. In the intervention group, significant decreases in pain and anxiety compared to the control group were observed after the intervention (p<0.001, eta2=0.202-0.332). NPY levels post-intervention were significantly lower than in controls (t=2.95, p=0.012; Cohen’s d=1.12) and there was a statistically significant effect of the intervention over time even after adjustment for severity of illness (SOFA scores) (LMM F=3.56, p=0.03) The effects of the intervention on fasL (LMM F=3.68), HMGB-1 (LMM F=1.986) and OCT (LMM F=0.58) levels were not statistically significant. Statistically significant associations were observed between NPY and fasL levels (LMM F=16.18, p<0.0001).
Conclusion: These results provide preliminary evidence of potential effects of an integrative relaxation-inducing intervention on serum NPY levels in critically ill patients. NPY is one of the most sensitive and consistent peptides in stress with anxiolytic and vasoactive effects. The clinical significance of these results, along with potential effects of integrative relaxation-inducing interventions on inflammatory markers, merit further investigation.


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