Efficacy of Pulmonary Rehabilitation in Patients with Copd in the Intensıve Care Unit

Efficacy of Pulmonary Rehabilitation in Patients with Copd in the Intensıve Care Unit Introduction: Serious problems on muscle strength and functional status can be seen in bedridden COPD patients who are receiving mechanical ventilation support. We aimed to investigate the effects of active extremity mobilization and neuromuscular electrical stimulation (NMES) and impact on inflammatory mediators in COPD patients receiving mechanical ventilatory support. Materials and methods: Between 2012 and 2014, conscious 30 patients (F/M:15/15) who were hospitalized in the intensive care unit (ICU) due to diagnosis of COPD and respiratory failure, were enrolled to the present study. Patients were divided into three groups, consisted of 10 patients for each. Active-passive extremity exercise training and NMES were applied to Group I, NMES was applied to Group II and active-passive extremity exercise training was applied to Group III. Muscle strength and mobilization time were evaluated before and after the rehabilitation. Serum IL-6, IL-8, IL-10 and TNF-α levels were evaluated in pre and post rehabilitation programme. Results: Lower extremity muscle strength was significantly improved in Group I and II after rehabilitation. Upper extremity muscle strength was also significantly improved in all groups. There was no significant difference between the duration of mobilization among all groups. In terms of discharge duration from the intensive care unit, there was no significant difference among groups. Significant reductions in erytrocyte sedimentation rate and CRP levels in Group II patients were observed after rehabilitation. After rehabilitation, there was a significant decrease in serum IL-6 level in Group I and in serum IL-8 level in group I and II. There was no significant difference in terms of IL-10 and TNF-α level in three groups. Conclusion: This study indicates that pulmonary rehabilitation can prevent the loss of muscle strength in intensive care. Presence of significant improvement in muscle strength only in Group II supports the idea that NMES can increase muscle strength without increasing cardiac afterload. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden intensive care unit patients who are mechanically ventilated.