Passive mobilization in patients with septic shock: heart autonomic response and influence of vasative drugs

• Grant number: 19/23545-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: August 01, 2020
• End date: July 31, 2021
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Renata Gonçalves Mendes
• Grantee: Maria Julia Checo Melger
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil

Abstract

Sepsis is defined as organ dysfunction caused by infection and septic shock requires appropriate volume replacement and the need for vasopressors. This critical patient is suffering from several organic impairments, including dysfunction in cardiac autonomic modulation. It is important to consider that in addition to the disease and its impairments, bed immobilization predisposes this patient to other physiological damage. Thus, early mobilization is a rehabilitating strategy of interest, however in the face of impaired cardiac control and concomitant use of vasoactive drugs (VAD), there is still no information on the cardiac autonomic response to a passive mobilization protocol. Objective: To investigate the cardiac autonomic response to passive mobilization in patients with septic shock and the association with VAD. Methods: The sample will consist of 20 individuals of both sexes, diagnosed with septic shock. These individuals will be divided into 2 groups, G1 or control and G2 (intervention - passive mobilization). For the evaluation of cardiac autonomic modulation, linear and non-linear indices for the analysis of heart rate variability (HRV) will be used, such as: mean HR, mean RR, STDRR, rMSSD, TINN, BF, AF, BF / A, approximate entropy (ApEn ) and sample entropy (SampEn). These indices will be obtained by analyzing the heart rate signal obtained beat by beat in the following moments: 1.Before; 2. During and 3. After the passive mobilization protocol (MP). The MP will consist of passive joint mobilization, with 10 repetitions for each movement, involving the joints of the ankles, knees, hips, wrists, elbows and shoulders, respectively, and the VAD will be recorded as to the type and dosage of administration. For analysis between groups (G1 and G2), the unpaired t-test will be used for data considered normal and the Mann-Whitney test for data considered non-normal. In the intra-group analysis (G2), the conditions of rest, mobilization and recovery will be analyzed by the one-way ANOVA test and to verify the association between the use of vasoactive drugs and the responses of the HRV variables, the following moments will be analyzed: ” (exercise - rest) and ” (recovery - exercise) for this, Pearson or Spearman's correlation coefficient will be used for data with normal and asymmetric distribution, respectively, with a significance level of 5% (p <0.05 ). Expected results: It is hoped that the results found may provide support for strengthening evidence-based practice that involves the scenario of early mobilization in critically ill patients for understanding the autonomic responses to a physical therapy intervention. Hypothesis: There will be a difference for HRV variables between the moments of rest, exercise and recovery, in addition to a negative association between the use of vasoactive drugs (noradrenaline, dobutamine) and MAC indexes in relation to parasympathetic modulation (AF, rMSSD, ApEn, SampEn) and positive association with MAC indexes related to predominantly sympathetic and / or total modulation (BF, BF / AF, STDRR, TINN) in patients with septic shock undergoing passive mobilization.