Effect of Graded Passive Cycling on Cerebral Blood Flow, Cardiac Function, and Global Hemodynamics in Sepsis
CCCF ePoster library. Chen J. Nov 9, 2018; 233432; 96
Ms. Jennifer Chen
Ms. Jennifer Chen
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INTRODUCTION: Passive cycling (PC) is a practical intervention that may improve functional outcomes and decrease pain in septic patients, possibly by reducing inflammation (Amidei, 2013) in early stages of sepsis when active exercise is not feasible due to sedation. It is a safe and feasible intervention in intensive care units (ICU) (Pires-Neto, 2013) despite increasing oxygen consumption in mechanically ventilated patients (Savi, 2010). However, while it can benefit patients by preserving muscle mass and strength (Hickmann, 2018), it can potentially lead to impaired distal organ perfusion. Furthermore, the effective dose of PC may vary between patients. The effect of PC on distal organ perfusion, and variation in patient responses to differing intensities of passive exercise remains unknown. These factors are critical to establishing the safety and appropriate dosage of PC in individual critically ill patients during the acute phase of their illness.


OBJECTIVES: 1) To observe the effect of PC on global hemodynamics, cerebral blood flow, and heart function in septic patients. 2) To observe the optimal intensity of PC in patients.


METHODS: We used Finapres® NOVA and intravenous monitoring, transcranial Doppler, and speckle-tracking echocardiography to measure global hemodynamics, middle cerebral artery velocity (MCAv, an indicator of cerebral blood flow) and cardiac function (left ventricular ejection fraction [EF] and global longitudinal strain [GLS]) during incremental increases of in-bed PC intensity in septic patients. The protocol started and ended with 5 minutes of baseline measurements at rest. PC intensity was progressively increased from 5 to 55 rotations per minute (RPM) in 10 RPM increments, with each experimental stage lasting 5 minutes. Mean values were calculated for all measured parameters during the last 2 minutes of each experimental stage. ANOVA was used to determine difference between experimental stages both within and between patients.


RESULTS: Ten septic patients (6 males, 4 females: age 53.3 ± 9.8 years) completed the protocol within 1-3 days of sepsis onset. Increasing PC intensity had no effect on global hemodynamics, but was associated with a dose-dependent decrease in MCAv, and an improvement in both EF and GLS. The changes in MCAv, EF, and GLS were not uniform across patients, occurring at different PC intensities in some, while not changing in others.


CONCLUSIONS: In contrast to healthy volunteers (Chen et al, 2017), increasing PC intensity in septic patients is associated with a dose-dependent decrease in cerebral blood flow and improvement in heart function, despite stable hemodynamics. Furthermore, the PC intensity that results in these changes varies between patients. Our results are the first to show that in-bed PC can induce changes in distal organ function, improving heart contractility in a dose-dependent manner. However, this may come at the expense of brain perfusion. The PC intensity dose that results in these changes differs between patients, suggesting the need for its individualized prescription in individual patients.

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