Investigation of the repercussion of a muscle training session with restriction of blood flow in vascular compliance, inflammation, gravity and mortality in critical patients

• Grant number: 20/06004-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: November 01, 2020
• End date: October 31, 2021
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Renata Gonçalves Mendes
• Grantee: Pierra Barusco Baptista
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil

Abstract

Low physical mobility is responsible for atrophy and muscle weakness in the Intensive Care Unit (ICU) which are associated with organic inflammation, system dysfunctions, worsening severity and mortality. Among the main dysfunctions of systems, the dysfunction of arterial compliance is highlighted by the association with worsening severity and mortality, although not demonstrated in critically ill patients. Still in non-critical patients, arterial stiffness is associated with C-reactive protein (CRP), a biomarker of systemic inflammation, and creatinophosphokinase (CPK), a biomarker of tissue damage inflammation. Despite this, the role of PCR and CPK in the dysfunction of critical arterial compliance remains unknown. Therefore, studies on the dysfunction of arterial compliance, inflammation, severity and mortality in the ICU are necessary, in addition to investigating the prevention of the deleterious effects of low critical mobility. In this regard, passive mobilization (PM) promotes a reduction in inflammatory responses and, associated with blood flow restriction (RFS), a reduction in muscle atrophy in comatose patients in the ICU. In addition, the traditional active exercise associated with RFS promotes no change in arterial compliance, but in the detraine of non-serious individuals. In view of this, it is also necessary to study the effect of PM and the combination of PM and RFS on the acute response of arterial, inflammatory compliance and severity and mortality of patients in the ICU. Objectives: To analyze and compare the effect of a session of MP and MP associated with RFS on the acute response of arterial, inflammatory compliance and of the severity and mortality of patients in the ICU. Methods: Sixteen patients within 18 hours of coma upon admission or admission to the ICU will be randomly allocated and balanced to one of the two muscle training groups: MP and MP associated with RFS. Immediately after the training session (T1), arterial compliance will be assessed by analyzing the pulse wave velocity (VOP), wave reflection, pulse transit time (TTP), increase pressure (PA), amplification index (IAx) and amplification index adjusted to the heart rate of 75 bpm (IAx75) by means of transcutaneous applanation tonometry, in addition to the state of severity and mortality predicted by the application of the Simplified Acute Physiology Score 3 (SAPS 3) score. After 6 hours of the training session (T2), the predicted severity and mortality, as well as the serum concentration of CRP and CPK will be analyzed using the ELISA test. For statistical analysis, the Shapiro Wilk test, mixed model analysis and Pearson correlation analysis for the association of PWV changes and wave reflection with those of PCR, CPK, disease severity and mortality will be used, as well as the level of significance of P <0.05.