Metabolic load during morning care and active bed exercises in critically ill patients: An explorative study

Abstract

Background: To avoid overexertion in critically ill patients, information on the physical demand, i.e., metabolic load, of daily care and active exercises is warranted.

Objective: The objective of this study was toassess the metabolic load during morning care activities and active bed exercises in mechanically ventilated critically ill patients.

Methods: This study incorporated an explorative observational study executed in a university hospital intensive care unit. Oxygen consumption (VO₂₎ was measured in mechanically ventilated (≥48 h) critically ill patients during rest, routine morning care, and active bed exercises. We aimed to describe and compare VO₂ in terms of absolute VO₂ (mL) defined as the VO₂ attributable to the activity and relative VO₂ in mL per kilogram bodyweight, per minute (mL/kg/min). Additional outcomes achieved during the activity were perceived exertion, respiratory variables, and the highest VO₂ values. Changes in VO₂ and activity duration were tested using paired tests.

Results: Twenty-one patients were included with a mean (standard deviation) age of 59 y (12). Median (interquartile range [IQR]) durations of morning care and active bed exercises were 26 min (21-29) and 7 min (5-12), respectively. Absolute VO₂ of morning care was significantly higher than that of active bed exercises (p = 0,009). Median (IQR) relative VO₂ was 2.9 (2.6-3.8) mL/kg/min during rest; 3.1 (2.8-3.7) mL/kg/min during morning care; and 3.2 (2.7-4) mL/kg/min during active bed exercises. The highest VO₂ value was 4.9 (4.2-5.7) mL/kg/min during morning care and 3.7 (3.2-5.3) mL/kg/min during active bed exercises. Median (IQR) perceived exertion on the 6-20 Borg scale was 12 (10.3-14.5) during morning care (n = 8) and 13.5 (11-15) during active bed exercises (n = 6).

Conclusion: Absolute VO₂ in mechanically ventilated patients may be higher during morning care than during active bed exercises due to the longer duration of the activity. Intensive care unit clinicians should be aware that daily-care activities may cause intervals of high metabolic load and high ratings of perceived exertion.

Keywords: Critically ill adults; Intensive care; Metabolic load; Oxygen consumption.