The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation

Simon Wernhart,Jürgen Hedderich,Svenja Wunderlich,Karsten Siemon,Eberhard Weihe,Dominic Dellweg,Kunigunde Schauerte

doi:10.1186/s40798-021-00299-6

Abstract

BackgroundIntensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation.Methods and ResultsWe retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46). Patients conducted moderate continuous (MCT, n = 24, mean age 70.3 ± 10.1 years) or high-intensity interval training (HIIT, n = 22, mean age 63.6 ± 12.6 years). The intensity of training was monitored with the BORG CR10 scale (intense phases ≥ 7/10 and moderate phases ≤ 4/10 points). The primary outcome was improvement (∆-values) of six-minute-walk-test (6 MWT), while the secondary outcomes were improvement of vital capacity (VCmax), forced expiratory volume in 1 s (FEV1), maximal inspiratory pressure (PImax) and functional capabilities (functional independence assessment measure, FIM/FAM and Barthel scores) after 3 weeks of training. No adverse events were observed. There was a trend towards a greater improvement of 6 MWT in HIIT than MCT (159.5 ± 64.9 m vs. 120.4 ± 60.4 m; p = .057), despite more days of invasive ventilation (39.6 ± 16.8 days vs. 26.8 ± 16.2 days; p = .009). VCmax (∆0.5l ± 0.6 vs. ∆0.5l ± 0.3; p = .462), FEV1 (∆0.2l ± 0.3 vs. ∆0.3l ± 0.2; p = .218) PImax (∆0.8 ± 1.1 kPa vs. ∆0.7 ± 1.3pts; p = .918) and functional status (FIM/FAM: ∆29.0 ± 14.8pts vs. ∆30.9 ± 16.0pts; p = .707; Barthel: ∆28.9 ± 16.0 pts vs. ∆25.0 ± 10.5pts; p = .341) improved in HIIT and MCT.ConclusionsWe demonstrate the feasibility and safety of HIIT in the early rehabilitation of ICUAWS patients. Larger trials are necessary to find adequate dosage of HIIT in ICUAWS patients.

Highlights

Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation
Patients suffering from severe ICUAWS unable to increase workload at early rehabilitation facilities (ERF) admission were allocated to the moderate continuous training (MCT) group, the others to the High-intensity interval (HIIT) group
We analysed a total of 46 patients, 24 in the MCT and 22 in the HIIT group

Summary

Introduction

Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Several studies have demonstrated improvements in aerobic capacity (VO2peak) as well as cardiac remodelling in heart failure patients with reduced ejection fraction (HFrEF) treated with HIIT [9]. HIIT seems to improve left- and rightventricular contractile function [10], and reduces rightventricular hypertrophy [11] and the burden of depression in heart failure patients [12]. It may unfold extra-cardiac effects, for instance by altering DNA methylation to improve retinal microvasculature [13], or may alleviate endothelial dysfunction [14]

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