ICU Acquired Weakness
Conditions
Keywords
mechanical ventilation, ICU Acquired Weakness, Arm Chair, Sitting, Early mobility
Brief summary
Chair positioning is one of a series of early mobilization techniques. At present, this technique, which involves moving a patient out of the resuscitation bed, can be performed passively or actively. It does not constitute a rehabilitative act as such, but it is considered in common paradigms as a technique to improve the patient's breathing and strength. However, recommendations issued in 2013 by the Society of intensive care physiotherapy and the society Société de réanimation de langue française (SRLF), reveal that this chair position cannot be recommended with a high grade. The aim of the investigators is therefore to break down this early mobilization process in intensive care, to find out whether the armchair is an indispensable tool for improving functional and muscular processes. The research hypothesis is therefore as follows: Early armchairing of the resuscitation patient, improves functional recovery compared to a conservative positioning strategy (sitting in bed).
Interventions
OTHERsitting out of bed in an arm-chair position
Once the patient has been awake with a RASS score between -1 and +1 for more than 12 hours, he or she must be placed in a chair (by any means) every day for a minimum of 30 minutes until discharge from intensive care (or until D28, depending on which comes first), unless there are transient contraindications. If the patient is unable to signal his or her wish to stop the chair session, the criteria for intolerance will be sought and the patient placed in the chair, but in all cases the chair session will not exceed 4 hours.
Sponsors
Centre Hospitalier Régional d'Orléans
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patient \> 18 years old 2. Patient on invasive mechanical ventilation for more than 24 hours 3. Patient in recovery phase with a RASS score greater than -3 for more than 12 hours 4. Stay expected to last 48 hours 5. Patient has never been placed in a chair during this hospitalization in intensive care. 6. Fragility score \< 6, during the month preceding admission to intensive care 7. Patient (or support person/relative if patient is unable to participate) who has agreed to take part in the study.
Exclusion criteria
1. Patient with an absolute and non-resolving contraindication to chair positioning 1. Fracture or orthopedic disorder contraindicating mobilization out of bed 2. Obesity with body mass index greater than 45 kg/cm2 3. Sacral eschar stage greater than 2 2. Patient using a wheelchair for mobility (i.e. paraplegic patient or patient with progressive neurological pathology). 3. Patient treated with veno-venous or veno-arterial ECMO at the time of screening. 4. Moribund patient 5. Encephalic death 6. Acute polyradiculoneuritis (Guillain-Barré syndrome) 7. Myasthenia 8. Patient treated by continuous hemodialysis or hemofiltration for more than 72 hours following the onset of awakening. 9. Complete transmetatarsal or higher amputation of one or both lower limbs. 10. Protected person (under guardianship or curatorship) 11. Person under court protection 12. Person not affiliated to a social security scheme 13. Pregnant or breast-feeding woman 14. Patient already included in the study 15. Patient taking part in an interventional clinical study, the aim of which is to show an improvement in functional level on discharge from the intensive care unit or which focuses on the theme of early rehabilitation in the intensive care unit.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional level on discharge from intensive care | On discharge from intensive care or day 28 (depending on which comes first) | Functional level at discharge from the intensive care unit measured by the Physical Function ICU Test scored (PFIT-s). Minimum value = 0 , meaning worse functionnal status Maximum value = 12, meaning better functionnal status |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MRC sum score | Day 28 | Presence of muscular weakness acquired in intensive care Minimum value = 0, meaning no muscular contraction Maximum value = 60, meaning normal muscular force |
| Length of stay in intensive care unit | Day 28 | — |
| Ventilator free days | Day 28 | Number of days without invasive mechanical ventilation |
| ICU Mobility scale | Day 28 | Maximum level of mobility achieved Minimum value = 0, meaning no mobility Maximum value = 10, meaning walking without assistance |
| Total length of hospital stay | Day 28 | — |
| Mortality | Month 6 | — |
| Mortality rate | Day 28 | — |
Countries
France
Contacts
Primary ContactGuillaume FOSSAT
Outcome results
None listed