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Patterns of vascular response immediately after passive mobilization in patients with sepsis: an observational transversal study

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Abstract

Sepsis is a serious organ dysfunction leading to endothelial damage in critical patients. Physiologically, there is an augment of vascular diameter in response to increased vascular blood flow and shear stress stimulus. However, the pattern of vascular response in face of passive mobilization (PM), an early mobilization physical strategy, has not yet been explored in patients with sepsis. To explore patterns of vascular response to PM and associations with clinical and cardiovascular profile in patients with sepsis. Cross-sectional, single-arm study. Thirty-two patients diagnosed with sepsis were enrolled. Vascular response was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound, before and after PM. The PM (to assess the response pattern) and SR (shear rate) were also calculated. PM protocol consisted of knees, hips, wrists, elbows, shoulders, dorsiflexion/plantar flexion movements 3 × 10 repetitions each (15 min). Arterial stiffness was assessed by Sphygmocor®, by analyzing the morphology and pulse wave velocity. Cardiac autonomic modulation (CAM) was assessed by analyzing heart rate variability indexes (mean HR, RMSSD, LF, HF, ApEn, SampEn, DFA). Different vascular responses were observed after PM: (1) increased vascular diameter (responders) (n = 13, %FMD = 11.89 ± 5.64) and (2) reduced vascular diameter (non-responders) (n = 19, %FMD= −7.42 ± 6.44). Responders presented a higher non-linear DFA2 index (p = 0.02). There was a positive association between FMD and DFA (r = 0.529; p = 0.03); FMD and SampEn (r = 0.633; p < 0.01). A negative association was identified between FMD and LF (Hz) (r= −0.680; p < 0.01) and IL-6 (r= −0.469; p = 0.037) and SR and CRP (r= −0.427; p = 0.03).

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Acknowledgements

We would like to thank the professionals from Fraternity of the Santa Casa Misericordia Hospital of São Carlos for their support with data collection.

Funding

This study was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil [grant number 428073/2016-6], financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 and FAPESP [grant number 2015/26501-1].

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Authors and Affiliations

  1. Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil

    Débora Mayumi de Oliveira Kawakami, Thaís Marina Pires de Campos Biazon, Flávia Cristina Rossi Caruso Bonjorno, Audrey Borghi-Silva & Renata Gonçalves Mendes

  2. Department of Medicine, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil

    José Carlos Bonjorno-Junior

  3. Intensive Care Unit, Fraternity of the Santa Casa de Misericordia Hospital of São Carlos, São Carlos, São Paulo, Brazil

    Tamara Rodrigues da Silva Destro

  4. University Hospital of the Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil

    Naiara Molina Garcia

  5. Department of Physical Therapy, Federal University of São, Carlos - Rod. Washington Luis, km 235 , São Carlos, São Paulo, 13565-905, Brazil

    Renata Gonçalves Mendes

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  1. Débora Mayumi de Oliveira Kawakami
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Débora Mayumi de Oliveira Kawakami, Tamara Rodrigues da Silva Destro, Thaís Marina Pires de Campos Biazon, Naiara Molina Garcia and Flávia Cristina Rossi Caruso Bonjorno. The first draft of the manuscript was written by Débora Mayumi de Oliveira Kawakami, José Carlos Bonjorno-Junior, Audrey Borgh-Silva and Renata Gonçalves Mendes and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Renata Gonçalves Mendes.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [University of Sao Carlos (CAAE: 58405916.4.0000.5504, protocol number: 2.363.397)]. and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kawakami, D.M.d.O., Bonjorno-Junior, J.C., da Silva Destro, T.R. et al. Patterns of vascular response immediately after passive mobilization in patients with sepsis: an observational transversal study. Int J Cardiovasc Imaging 38, 297–308 (2022). https://doi.org/10.1007/s10554-021-02402-0

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