Corporeal rehabilitation to manage acute stress in critically ill patients

Bourgeon-Ghittori, Irma; Couette, Maryline; Marini, Sylvie; Ouedraogo, Rachida; Alves, Aline; Razazi, Keyvan; Carras, Damien; Pallud, Ann-Cecile; Kentish-Barnes, Nancy; Mekontso Dessap, Armand

doi:10.1186/s13613-022-01019-3

Annals of Intensive Care

Table 3 Baseline evaluation, direct and remote assessment in critically ill patients, overall and depending on their response to corporeal rehabilitation care

From: Corporeal rehabilitation to manage acute stress in critically ill patients

Parameter	N	All patients (n = 287)	Non-responders (n = 99)	Responders (n = 188)	p value
Baseline evaluation
Pre-inclusion time (days)*	287	3 [2–7]	3 [2–7]	3 [2–7]	0.613
Days of IMV before inclusion	72	8 [5–22]	7 [4–23]	9 [5–20]	0.582
Hemodynamics
Heart rate (bpm)	287	90 [79–104]	90 [78–102]	90 [80–104]	0.612
SAP (mmHg)	287	127 [115–141]	127 [115–141]	128 [114–141]	0.750
DAP (mmHg)	287	70 [62–80]	68 [60–79]	71 [63–82]	0.048
MAP (mmHg)	287	92 [82–101]	92 [82–98]	92 [82–102]	0.504
Comfort
Pain score	263	4 [0–6]	3 [0–6]	4 [0–7]	0.108
Stress score	263	4 [0–7]	0 [0–5]	5 [0–7]	< 0.001
Dyspnea score	112	2 [1–3]	2 [0–3]	2 [1–3]	0.690
Well-being score	259	5 [4–7]	6 [5–8]	5 [3–6]	< 0.001
Discomfort	287	45 (16%)	15 (15%)	30 (16%)	0.858
Neurological function
Continuous sedation or analgesia	287	10 (4%)	1 (1%)	9 (5%)	0.173
Midazolam	287	1 (0%)	0 (0%)	1 (1%)	> 0.99
Sufentanyl	287	9 (3%)	1 (1%)	8 (4%)	0.171
Neuroleptic	287	2 (1%)	0 (0%)	2 (1%)	0.547
Morphine	287	64 (22%)	18 (18%)	46 (25%)	0.224
Physical disability	287	20 (7%)	5 (5%)	15 (8%)	0.354
Ventilation
IMV	286	25 (9%)	9 (9%)	16 (9%)	0.848
Assist-control mode	287	2 (1%)	2 (2%)	0 (0%)	0.118
Tidal volume (mL)	30	517 [420–591]	455 [394–254]	541 [478–642]	0.081
Tidal volume (mL/kg IPW)	28	8 [7–10]	8 [6–9]	9 [7–10]	0.248
End-tidal CO₂ mmHg	25	33 [29–38]	33 [28–38]	31 [28–37]	0.755
FiO₂ (%)	39	35 [30–45]	35 [30–48]	35 [30–40]	0.739
Oxygen flow (L/min)	217	0 [0–2]	0 [0–2]	0 [0–2]	0.937
SpO₂ (%)	287	97 [95–99]	97 [95–99]	97 [95–99]	0.586
Respiratory rate (bpm)	287	22 [18–27]	22 [18–28]	22 [18–27]	0.635
Intercostal retraction	287	5 (2%)	2 (2%)	3 (2%)	> 0.99
Paradoxical breathing	287	8 (3%)	2 (2%)	6 (3%)	0.719
Last available blood gases
pH	235	7.43 [7.39–7.47]	7.43 [7.40–7.47]	7.43 [7.38–7.46]	0.213
PaO₂/FiO₂ ratio (mmHg)	234	333 [238–417]	333 [217–416]	339 [250–418]	0.664
PaCO₂ (mmHg)	234	38 [32–44]	36 [33–44]	38 [32–44]	0.741
Bicarbonates (mmol/L)	234	26 [23–29]	26 [23–29]	26 [23–29]	0.771
Lactates (mmol/L)	234	1 [1–2]	1 [1–2]	1 [1–2]	0.941
SaO₂ (%)	235	96 [94–98]	96 [94–98]	96 [94–98]	0.745
Corporeal rehabilitation care (CRC)
Pre-evaluation time^# (min)	186	15 [5–30]	10 [4–27]	18 [7–31]	0.122
Face and forehead massage	287	204 (71%)	70 (71%)	134 (71%)	0.919
Manicure	287	61 (21%)	19 (19%)	42 (22%)	0.535
Pedicure	287	50 (17%)	19 (19%)	31 (17%)	0.566
Scalp massage	287	37 (13%)	13 (13%)	24 (13%)	0.930
Other interventions	287	51 (18%)	17 (17%)	34 (18%)	0.847
Duration of CRC (min)	287	25 [20–30]	25 [20–30]	25 [25–30]	0.016
Direct evaluation
Time from CRC^$ (min)	174	8 [3–15]	10 [2–17]	7 [4–15]	0.646
Hemodynamics
Heart rate (bpm)	286	89 [78–101]	84 [72–102]	91 [80–100]	0.105
SAP (mmHg)	286	128 [112–140]	129 [111–144]	127 [113–139]	0.661
DAP (mmHg)	286	71 [62–79]	69 [61–78]	72 [62–81]	0.186
MAP (mmHg)	286	91 [80–102]	93 [80–101]	91 [80–102]	0.742
Comfort
Pain score	258	2 [0–5]	3 [0–6]	2 [0–5]	0.223
Stress score	258	2 [0–5]	1 [0–5]	2 [0–5]	0.555
Dyspnea score	112	2 [1–2]	2 [1–2]	2 [1–2]	0.347
Well-being score	257	8 [6–10]	7 [5–8]	8 [6–10]	< 0.001
Discomfort	286	7 (2%)	3 (3%)	4 (2%)	0.694
Change in comfort^£
Δ1 Pain score	256	0 [− 2 to 0]	0 [0–0]	− 1 [− 3 to 0]	< 0.001
Δ1 Stress score	256	0 [− 2 to 0]	0 [0–0]	− 1 [− 3 to 0]	< 0.001
Δ1 Dyspnea score	112	0 [− 2 to 0]	0 [− 1 to 0]	0 [− 2 to 0]	0.870
Δ1 Well-being score	254	2 [0–4]	0 [0–1]	3 [1–5]	< 0.001
Ventilation
Respiratory rate (bpm)	286	21 [18–25]	21 [17–26]	21 [18–25]	0.820
Intercostal retraction	286	4 (1%)	2 (2%)	2 (1%)	0.609
Paradoxical breathing	286	2 (1%)	1 (1%)	1 (1%)	> 0.99
Patient appreciation of the CRC session
Usefulness	256	10 [8–10]	8 [7–10]	10 [8–10]	< 0.001
Satisfaction	256	10 [8–10]	9 [8–10]	10 [8–10]	0.002
Patient’s wish to renew care	260	249 (96%)	68 (94%)	181 (96%)	0.503
Remote assessment
Time from CRC^$$ (min)	131	71 [57–93]	63 [50–94]	72 [60–94]	0.165
Hemodynamics
Heart rate (bpm)	224	89 [79–100]	86 [76–100]	90 [80–100]	0.379
SAP (mmHg)	224	125 [112–138]	123 [109–134]	126 [113–139]	0.114
DAP (mmHg)	224	71 [60–80]	67 [57–78]	72 [61–82]	0.005
MAP (mmHg)	224	90 [79–100]	86 [77–97]	91 [81–102]	0.035
Discomfort	223	10 (5%)	2 (3%)	8 (5%)	0.728
Comfort
Δ2 Pain sore	204	2 [0–5]	0 [0–5]	2 [0–5]	0.752
Δ2 Stress score	203	0 (0–5]	0 (0–5]	0 (0–5]	0.705
Δ2 Dyspnea score	111	2 [1–2]	2 [1–3]	2 [1–2]	0.723
Δ2 Well-being score	203	8 [6–10]	7 [5–9]	8 [6–10]	0.043
Change in comfort^£
Δ2 Pain score	202	0 [− 2 to 0]	0 [0–0]	0 [− 2 to 0]	0.012
Δ2 Stress score	202	0 [− 2 to 0]	0 [0–0]	− 1 [− 3 to 0]	< 0.001
Δ2 Dyspnea score	111	0 [− 1 to 0]	0 [0–0]	0 [− 1 to 0]	0.673
Δ2 Well-being score	202	1 [0–4]	0 [0–1]	2 [0–4]	< 0.001
Ventilation
Respiratory rate (bpm)	224	21 [17–26]	20 [17–25]	22 [18–26]	0.431
Intercostal retraction	223	2 (1%)	1 (1%)	1 (1%)	0.530
Paradoxical breathing	223	2 (1%)	2 (3%)	0 (0%)	0.98
Outcome
ICU stay (days)	287	6 [4–12]	6 [4–12]	7 [4–14]	0.528
Death at day 28	287	22 (8%)	15 (15%)	7 (4%)	0.001

Δ1: absolute difference between the value at direct evaluation and the value at baseline; Δ2: absolute difference between the value at remote evaluation and the value at baseline
IMV invasive mechanical ventilation, IPW ideal predicted weight, CO₂ carbon dioxide, FiO₂ inspired oxygen fraction, SpO₂ oxygen transcutaneous saturation
*Days between ICU admission and inclusion
^#Time between baseline assessment and CRC start in minutes
^$Time between CRC end and direct intervention assessment in minutes
^$$Time between CRC end and remote evaluation in minutes
^£Change in score as compared with baseline

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