Shunsuke Taito

Early mobilization of mechanically ventilated patients in the intensive care unit

Several recent studies have suggested that the early mobilization of mechanically ventilated patients in the intensive care unit is safe and effective. However, in these studies, few patients reached high levels of active mobilization, and the standard of care among the studies has been inconsistent. The incidence of adverse events during early mobilization is low. Its importance should be considered in the context of the ABCDE bundle. Protocols of early mobilization with strict inclusion and exclusion criteria are needed to further investigate its contributions.

Pulmonary Oxidative Stress Is Induced by Maximal Exercise in Young Cigarette Smokers

INTRODUCTION Oxidative stress is induced by both cigarette smoking and acute exercise. It has also been reported that exercise can induce plasma oxidative stress in young cigarette smokers. However, no previous report has demonstrated that exercise induces pulmonary oxidative stress in cigarette smokers. The aim of this study was to determine whether pulmonary oxidative stress is induced by maximal exercise in cigarette smokers as measured by reactive oxygen species generation and total antioxidant content. METHODS Fifteen male smokers (mean age: 25.9 ± 2.9 years) and 18 male nonsmokers (mean age: 24.2 ± 4.3 years) participated in this study. Hydrogen peroxide (H(2)O(2)) concentration and biological antioxidant potential (BAP) in exhaled breath condensate (EBC) were measured at baseline and after maximal exercise in the Wingate anaerobic test. RESULTS A significant interaction of group by time was observed for EBC H2O2 concentration (p = .015). After exercise, EBC H(2)O(2) concentrations were significantly increased in the smoking group (p = .030) but not in the nonsmoking group. There were no significant changes in EBC BAP in either group. CONCLUSIONS These findings indicate that in cigarette smokers, maximal exercise induces pulmonary oxidative stress, which may lead to oxidative damage in the lungs.

Cigarette Smoking does not Induce Plasma or Pulmonary Oxidative Stress after Moderate-intensity Exercise.

[Purpose] Cigarette smoking increases oxidative stress, which is a risk factor for several diseases. Moreover, strenuous exercise has been shown to induce plasma and pulmonary oxidative stress in young cigarette smokers. However, no previous reports have demonstrated whether plasma and pulmonary oxidative stress occur after moderate-intensity exercise. Therefore, the aim of this study was to clarify whether moderate-intensity exercise induces pulmonary and plasma oxidative stress in smokers. [Subjects] Ten young male smokers and 10 young male nonsmokers participated in this study. [Methods] Plasma hydroperoxide concentrations were measured at baseline and then immediately and 15 min after moderate-intensity exercise. Hydrogen peroxide concentrations in exhaled breath condensate were measured at baseline and after exercise. [Results] No significant interactions were found between smokers and nonsmokers in terms of hydroperoxide or hydrogen peroxide concentrations following moderate-intensity exercise at any time point. [Conclusion] These findings suggested that moderate-intensity exercise did not induce plasma or pulmonary oxidative stress in young cigarette smokers.

The neural influence on the occurrence of locomotor–respiratory coordination

This study focused on the neurogenic mechanisms of coordination between locomotor and respiratory rhythms. The aim of the present study was to investigate the influence of peripheral neurogenic drive from moving limbs, and the level of consciousness, on locomotor-respiratory coordination. Subjects performed movement for 20 min in a supine position using a bicycle ergometer. The movement comprised three types of leg movements: active (loadless) movement, passive movement while awake and passive movement during sleep. We found no difference between active and passive movement in the degree of coordination. However, the degree of coordination during sleep was significantly lower than that while awake (p<0.05). We conclude that peripheral neurogenic drive from moving limbs is able to generate locomotor-respiratory coordination, and that the level of consciousness may influence the degree of coordination.

Plasma oxidative stress is induced by single‐sprint anaerobic exercise in young cigarette smokers

Cigarette smoking increases oxidative stress, which is a risk factor for several diseases. Smoking has also been reported to enhance plasma oxidative stress during strenuous exercise. However, no prior study has examined the changes in plasma oxidative stress after single‐sprint anaerobic exercise in cigarette smokers. The purpose of this study was to investigate these changes in young cigarette smokers by measuring reactive oxygen species generation and total antioxidant content. Participants were 15 male smokers (mean age: 25·9 ± 2·9 years) and 18 male non‐smokers (mean age: 24·2 ± 4·3 years). Hydroperoxide concentration and biological antioxidant potential (BAP) in plasma were measured at baseline and after the Wingate anaerobic test. A significant interaction between group and time was observed for plasma hydroperoxide concentration (P = 0·037). Plasma hydroperoxide concentration was significantly increased after exercise in both smokers and non‐smokers (P = 0·001 and <0·001, respectively). However, no significant interaction was observed between groups by time on plasma BAP (P = 0·574), and a main effect of time was observed (P<0·001). Plasma BAP was significantly increased after exercise in both groups (both, P<0·001). These findings indicate that plasma oxidative stress is higher in cigarette smokers than in non‐smokers after single‐sprint anaerobic exercise, which may increase the risk of oxidative damage.

Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group

We conducted an internet survey targeting healthcare providers in intensive care units (ICUs) in Japan and received 318 responses. Eighteen percent of respondents replied that full-time physical therapists (PTs) exist in their ICUs. Practicing sitting upright or sitting in a chair is frequently performed, while standing and walking are occasionally performed for patients undergoing mechanical ventilation. However, only 16 % of respondents use staged rehabilitation protocols. This preliminary survey suggests that full-time involvement of PTs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs.

The effect of exercise on blood fluidity: Use of the capillary model to assess the clogginess of blood.

AIM The goal was to evaluate the effects of exercise on the clogginess of blood as well as the effect of increased blood cell count and hematocrit levels after exercise. We also investigated the mechanisms underlying the clogginess of blood. METHODS The time required for blood to pass through microchannels was measured. We focused on assessing the consecutive passage times for serial 20 μL volumes. We used heparinized peripheral blood obtained from subjects after exercise conducted at three intensity levels. Blood samples were also adjusted to achieve specific hematocrit levels or supplemented by addition of adenosine diphosphate (ADP). RESULTS The sequential blood passage times of consecutive 20 μL volumes increased with platelet aggregation and adhesion of white blood cells (WBC). We also observed an increase with blood cell counts and hematocrit levels. These changes occurred after high intensity exercise but not after low or medium intensity exercise. Furthermore, the sequential blood passage times of 20 μL volumes increased with platelet aggregation and adhesion of WBC at an ADP concentration at the threshold of aggregation but not at higher levels of hematocrit. CONCLUSIONS These findings suggested that high intensity exercise might induce the clogginess of blood by enhanced platelet aggregation and adhesion of WBC.

Rehabilitation for patients with sepsis: A systematic review and meta-analysis

The objective of this systematic review was to determine whether rehabilitation impacts clinically relevant outcomes among adult patients with sepsis. Randomized controlled trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PEDro, and the World Health Organization International Clinical Trials Platform Search Portal, as well as conference proceedings and reference lists of relevant articles were collected. Two reviewers independently identified randomized controlled trials on the rehabilitation of patients with sepsis, and the two reviewers independently abstracted trial level data including population characteristics, interventions, comparisons, and clinical outcomes. Our primary outcomes were quality of life (QOL), activity of daily living (ADL), and mortality. Our secondary outcomes were length of stay, return to work, muscle strength, delirium, and all adverse events. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We included two trials enrolling 75 patients. The mean difference (95% confidence interval [CI]) of physical function and physical role in QOL measured by SF-36 were 21.10 (95% CI: 6.57–35.63) and 44.40 (95% CI: 22.55–66.05), respectively. Rehabilitation did not significantly decrease intensive care unit (ICU) mortality (risk ratio, 2.02 [95% CI: 0.46–8.91], I2 = 0%; n = 75). ICU length of stay and hospital length of stay and muscle strength were not statistically significantly different and no adverse events were reported in both studies. The certainty of the evidence for these outcomes was “very low.” Data on ADL, return to work, and delirium were not available in any of the trials. Rehabilitation of patients with sepsis might not decrease ICU mortality, but might improve QOL. Further, well-designed trials measuring important outcomes will be needed to determine the benefit and harm of rehabilitation among patients with sepsis.

Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes: A survey study

Purpose: The aim of this study is to clarify intensive care unit (ICU)‐level factors facilitating out‐of‐bed mobilization defined as a range of activities from sitting on edge of bed up to walking in mechanically ventilated patients with orotracheal tubes. Materials and methods: We conducted a survey of all intensive care units (ICUs) certified by the Japanese Society of Intensive Care Medicine (excluding pediatric ICUs) as training facilities for intensivists. Results: We surveyed 294 ICUs, with a response rate of 57% (n = 168). A dedicated physical and/or occupational and/or speech therapy team was present in 34 ICUs (20%). In 86 ICUs (51%), mechanically ventilated patients with orotracheal tubes also routinely underwent out‐of‐bed mobilization, and 38 ICUs (23%) used a written mobilization protocol. Factors independently associated with routine out‐of‐bed mobilization were the presence of a dedicated therapist in the ICU (odds ratio [OR], 6.83; 95% confidence interval [CI], 2.17–21.50; p = 0.001) and a high intensity physician staffing (OR, 2.37; 95% CI, 1.03–5.51; p = 0.043). Conclusions: Based on impression of professionals, the presence of dedicated therapist in the ICU, and the high intensity physician staffing are significantly associated with an increased rate of out‐of‐bed mobilization for mechanically ventilated patients with orotracheal tubes. HighlightsBased on impression of professionals, out‐of‐bed mobilization was routinely provided.Dedicated therapist is associated with an increased rate of out‐of‐bed mobilization.High intensity physician staffing is a significant factor for facilitating mobilization.

Do change of care and rehabilitation for patients with mechanical ventilation increase chances of return to work?: Discussion on organ support therapy in the intensive care unit and return to work: a nationwide, register-based cohort study

We wish to discuss the results of “Organ support therapy in the intensive care unit and return to work: a nationwide, register-based cohort study” [1]. The authors used the Danish registry data for 10 years, demonstrating that mechanical ventilation and longer ICU length of stay (LOS) were associated with reduced chance of returning to work. Mechanical ventilation is a risk factor of post intensive care syndrome (PICS), characterized by cognitive, psychiatric and/or physical impairment. Since 2010, an evidence-based organizational approach called the ABCDE bundle has been applied to patients with mechanical ventilation to help improve clinical outcomes [2]. Was mechanical ventilation associated with a decreased chance of return to work in the subgroup analysis of 2725 ICU survivors (2011– 2014)? Did difference in time period affect the hazard ratio for return to work? Additionally, rehabilitation for patients with critical illness is one typical strategic approach for supporting recovery following critical illness and addressing symptoms of PICS [3]. Is there a procedure code for rehabilitation in the Danish National Patient Registry? If some of the participants in this study were not provided rehabilitation services in the ICU as standard care, did being provided rehabilitation services change the relationship between mechanical ventilation and chances of return to work? The information regarding rehabilitation services might help the readers better understand the results. Elucidating the aforementioned factors might help us to better interpret the results of Riddersholm et al. and to establish better care and rehabilitation services to better support return to work.