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Early neurocognitive rehabilitation in critically ill patients during ICU stay: a safety study
Intensive Care Medicine Experimentalvolume 3, Article number: A994 (2015)
Critical illness result in significant long-term neurocognitive impairments that may persist for years after hospital discharge [1, 2]. These sequelae impact negatively in relatives' and patients' quality of life . However, neurocognitive rehabilitation rarely occurs after critical illness. The Early Neurocognitive Rehabilitation in Intensive Care-ENRIC protocol (ClinicalTrial: NCT02078206)- has been develop to apply neurocognitive stimulation in patients during ICU stay. This intervention includes neurocognitive stimulation exercises that can be performed from the patient's bed through Kinect technology and it is targeted to ameliorate neurocognitive outcomes at short-and long-term.
The aim of this study was to explore if the neurocognitive stimulation during ICU stay can produce deleterious effects over physiological status.
18 ICU participants received a 20 minutes Early Neurocognitive Rehabilitation session. Heart rate (HR), O2 saturation (SpO2) and respiratory rate (RR) were collected using BetterCare® system 20 minutes before, during and after the neurocognitive stimulation session. Safe ranges were calculated by age and sex and age in HR and RR respectively. Safe lower SpO2 limit was estimated at 90%. As safety criteria safe ranges and a change of 20% from baseline in any physiological parameter were considered.
100% of the sample presented HR values within normal limits at baseline (Mean= 92.3; min-max: 62.7-120.8), during (93.2; 75.6-120.7) and after session (93.4; 83.4-118.2). SpO2 values at baseline (95.7; 91.5-99.9), during (95.4; 91.8-100) and after session (95.7; range: 92.7-100) were within normal limits in all participants. 9 participants exceeded safe RR limits at baseline (27.6; 21.4-34), maintaining this status during (27.2; 22.1-34.3) and after session (27.9; 22.4-33.5). No changes greater than 20% were observed in any case. 2 new patients exceeded safe RR limits after session (26.5; 20.8-32.2), although only 1 participant showed a change greater than 20% (21.9%). No significant pre vs. post results were observed in any physiological variable (HR, p = 0.85; SpO, p = 0.98; RR, p = 0.23).
Neurocognitive stimulation in patients during ICU stay did not produce clinical relevant changes in the patients' physiological status. Thus, the early neurocognitive stimulation may be considered a safety intervention for critically ill patients.
Fundació La Marató TV3
Wolters AE, et al: Cognitive impairment after intensive care unit admission: a systematic review. Intensive Care Med. 2013, 39 (3): 376-86. 10.1007/s00134-012-2784-9.
Wilcox ME, et al: Cognitive dysfunction in ICU patients: risk factors, predictors, and rehabilitation interventions. Crit Care Med. 2013, 41 (9 Suppl 1): S81-98.
Hopkins RO, et al: Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005, 171 (4): 340-347. 10.1164/rccm.200406-763OC.