Impact of a Rehabilitation Protocol and a Dedicated Therapist in the Intensive Care Unit on Physical Function and Activities of Daily Living.

OBJECTIVES: The goal of this study was to determine the effects of an intensive care unit (ICU) rehabilitation protocol with dedicated therapists on the physical function and activities of daily living (ADL) of patients on discharge from the ICU. METHODS: This retrospective study included patients who started rehabilitation during their ICU stay. Patients were divided into three groups: the Usual Care group (before the introduction of the rehabilitation protocol), the Protocol group (after the introduction of the rehabilitation protocol), and the PT + Protocol group (with a dedicated therapist in addition to the rehabilitation protocol). The standard interventions in the Protocol group and the PT + Protocol group were set according to the protocol based on the level of consciousness and strength of each individual patient. Patients' age, APACHE II score, length of ICU stay, length of hospital stay, and the Functional Status Score for the ICU (FSS-ICU) and Medical Research Council score (MRC score) on discharge from the ICU were compared among the three groups. RESULTS: There were no significant differences among the three groups in age and APACHE II score. The MRC and FSS-ICU scores were significantly higher in the PT + Protocol and Protocol groups than in the Usual Care group. Furthermore, the lengths of ICU stay and hospital stay were lower in the PT + Protocol group than in the Usual Care group. CONCLUSIONS: Introduction of the rehabilitation protocol improved the limb strength and ADL of patients. Moreover, the presence of dedicated therapists in addition to the protocol reduced the lengths of ICU and hospital stays.

Association between Pulmonary Function and Stair-Climbing Test Results after Lung Resection: A Pilot Study.

Background: The stair-climbing test was used to assess the exercise capacity before lung resection in subjects with lung cancer. However, few studies have systematically evaluated the role of this exercise methodology as a postoperative test. The aim of the present study was to assess whether the stair-climbing test findings reflect the postoperative decrease in pulmonary function. Methods: Twenty subjects with non-small-cell lung cancer who underwent lung resection were enrolled in the study. Perioperative functional evaluation comprised the pulmonary function test, stair-climbing test, and 6-min walk distance test (6MWD). A correlation analysis was performed between the postoperative percentages of pulmonary function with respect to preoperative values and the exercise capacity. Results: No correlation was noted between the percentage changes in pulmonary function and those in 6MWD. However, there was a significant correlation between the percentage changes in forced expiratory volume in 1 s and those in the altitude reached in the stair-climbing test (r=0.46, p < 0.05) and between the percentage changes in carbon monoxide lung diffusion capacity and those in the altitude (r=0.54, p < 0.05). Conclusions: The stair-climbing test findings might be effective at detecting changes in exercise capacity induced by postoperative decrease in pulmonary function.

Comparison between stair-climbing test and six-minute walk test after lung resection using video-assisted thoracoscopic surgery lobectomy.

[Purpose] Currently, the six-minute walk distance (6MWD) is used to evaluate exercise capacity in people following lung resection for non-small cell lung cancer. However, it is unclear whether the 6MWD can detect changes in cardiorespiratory fitness induced by exercise training or lung resection. Conversely, the stair-climbing test is used frequently for the preoperative evaluation of lung resection candidates. It is considered a sensitive method for detecting changes associated with training, but is not used to evaluate exercise capacity after lung resection. The purpose of this study was to compare the stair-climbing test and the six-minute walk test (6MWT) after lung resection. [Subjects and Methods] Fourteen patients undergoing lung resection completed the stair-climbing test and the 6MWT preoperatively, and one month postoperatively. The postoperative values and the percentage change in the stair-climbing test and the 6MWT were evaluated. [Results] The stair-climbing test results showed a significant deterioration at one month after lung resection; however, a significant change in the 6MWD was not observed. [Conclusion] When compared with the 6MWT, the stair-climbing test was more sensitive in detecting lung resection-induced changes in cardiorespiratory fitness.

Effects of the magnitude of pressure on the severity of injury and capillary closure in rat experimental pressure ulcers.

Experimental pressure ulcers were successfully produced in the rat abdominal wall at 100 mmHg in our previous study. We hypothesized that injury is less severe when pressures are lower than 100 mmHg and explored a critical pressure in the production of pressure ulcers. At 70 and 60 mmHg, repeated compressions for 4 h daily for 5 consecutive days resulted in partial skin necrosis and eschar formation in the majority of rats, whereas skin injuries were absent or very mild in most of the rats at 50 mmHg. The extent of ischemia was also examined by visualization of capillary blood flow using intravascular infusion of Lycopersicon esculentum lectin. Rat abdominal walls were compressed in the range from 0 (control) to 100 mmHg. The percentages of open capillaries were 62.8 ± 10.1% at 0 mmHg and 34.7 ± 18.5% at 10 mmHg. The ratio of open capillaries was further decreased with increasing pressure, but not pressure dependently. In conclusion, the severity of injury at 50 mmHg was drastically milder than that at 60 mmHg or higher, whereas the extent of ischemia (capillary closure) was not significantly different. The pressure is vitally important; however, other factor(s) besides ischemia is likely to promote the development of pressure ulcers.