Period Of Bed Rest Research Articles

Pediatric Blunt Solid Organ Injury: Beyond the APSA Guidelines

The APSA guidelines were published in 2000 making nonoperative management of pediatric blunt liver and spleen injury standard for most injured children. A review of recent literature supports significant changes in management of children with liver, spleen, as well as kidney injury. Of the >300 articles on pediatric abdominal injury since the publication of the APSA guidelines, no randomized controlled trials have been conducted. Six prospective studies, however, have been completed, and several large database studies add significant insights into our understanding of pediatric spleen, liver, and kidney injury. Significant decreases in use of resources can be safely applied to children with hemodynamic stability at presentation. Recent studies suggest management based on physiologic criteria rather than injury grade may result in improved resource utilization through shortened hospitalization, abbreviated periods of bedrest, decreased use of intensive care units, earlier return to school, fewer tests, and a lower transfusion threshold. New algorithms are now available to assist in management.

Favorable Single-Operator Experience with VasoSeal , a Vascular Closure Device with Extravascular Collagen in a Large High-Risk Cohort of Patients Undergoing Percutaneous Coronary Interventions

BACKGROUND: Prolonged duration of manual or mechanical compression at the site of femoral artery access after sheath removal upon completion of coronary procedures followed by extended period of bed rest has significant logistical and practical problems for both patients and hospital staff. The availability of vascular closure devices (VCDs) has ushered in a new era in the routine clinical practice in the catheterization laboratory. AIM: The aim of this prospective study was to assess the effectiveness and safety of the use of the VCD VasoSeal, a collagen plug, in patients undergoing cardiac catheterization and/or percutaneous coronary intervention (PCI). PATIENTS AND METHODS: VasoSeal was employed over 2.5 years in 388 consecutive patients mostly presenting with acute coronary syndromes and subjected mainly to PCI procedures performed via transfemoral arterial access. All the patients who underwent PCI were given 7,000 IU of heparin intravenously during the procedure and had been receiving or were acutely loaded with dual antiplatelet therapy (aspirin and clopidogrel). The majority (90.7%) of patients also received a platelet glycoprotein IIb/IIIa inhibitor during and for 12-14 hours after the procedure. The sheaths were removed at the end of the procedure and hemostasis achieved with VasoSeal. RESULTS: Deployment of the VCD was successful in 99.2%. Complete hemostasis without bleeding or hematoma was obtained in 95.4% of cases (370/388). In 3 patients VasoSeal could not be or was partially deployed. The mean time required for the placement of VasoSeal was 1 min. The mean time-to-hemostasis was 3 min. The mean time-to-mobilization was 3 hours. Only one patient developed a pseudoaneurysm of the right common femoral artery; the lesion was treated with ultrasonography -guided compression. In addition, 13 small local hematomas and 2 large inguinal hematomas (one requiring blood transfusion) were recorded. In 2 cases retroperitoneal bleeding occurred, requiring blood transfusion in one of them. Local infection (cellulitis) responding to antibiotic treatment was observed in 2 patients. No patient required local surgical intervention. CONCLUSION: VasoSeal was a safe collagen closure device characterized by a high success rate of deployment and highly successful hemostasis with few manageable complications in a very high-risk patient cohort undergoing PCI under heavy anticoagulation and antiplatelet drug therapy. In these patients this vascular closure device reduced the time-to-hemostasis and time-to-mobilization and the incidence of complications.

The Potential Role of β−Hydroxy−β−Methylbutyrate (HMB) in the Management of Lean Body Mass Loss in Older Adults with Heart Failure and Cardiac Cachexia

The loss of muscle mass and strength is a consequence of the aging process and can occur during periods of bed rest, inactivity, trauma, illness as well. For older adults with advanced heart failure (HF)- associated cachexia, disease-related loss of muscle mass and strength is a complication of the disease state and is associated with deconditioning and frailty. As patients with HF progress, the likelihood of developing malnutrition and cachexia increases. Cachexia is associated with lean body mass (LBM) loss and is correlated with a worsening prognosis in HF. Nutrition interventions beyond simple caloric replacement could be an important adjuvant therapy for a better clinical outcome. Specifically, nutrients that improve the muscle protein synthesis and decrease degradation are of special consideration for the management of cardiac cachexia. Dietary protein intake, oral nutrition supplements and β-hydroxy β- methylbutyrate (HMB) are few examples. HMB is the active metabolite of the essential amino acid leucine and is found in trace amounts in some foods. It has been shown to inhibit muscle proteolysis and modulate protein turnover. It is also been shown to stabilize muscle cell walls through the production of cholesterol within the muscle tissue. In the following review, we will focus on HMB as a potential nutritional compound that could help address the HF-associated loss of LBM and its consequences.

Collagen content in the vastus lateralis and the soleus muscle following a 90-day bed rest period with or without resistance exercises.

spaceflight seems associated with deterioration of the function of the skeletal muscles. Since muscle collagen is critical for muscle function, an improved understanding of the content of the muscle collagen during long-term inactivity seems important. Bed-rest with in-bed resistance training serves as a proxy for the conditions in space. Therefore, ground-based studies may improve the understanding of the consequences of long-term inactivity. the purpose is to compare the change in collagen protein in the vastus lateralis (VL) and the soleus (SOL) muscle amongst persons exposed to a 90-day bed rest with or without resistance exercise. an explorative analysis was completed based on data from a randomized, controlled trial. The intervention group (BRE, SOL n=4, VL n=8) performed supine-based squat exercises, whereas the controls (BE, SOL n=6, VL n=12) remained inactive during follow-up. Muscle biopsies from vastus lateralis and soleus were taken at baseline (pre) and after 90-days' follow-up (post). Muscle collagen (μg collagen/mg protein) was quantified. Two-way repeated measurements ANOVA was used to compare the interaction between the intervention (BRE/BR) and time (pre/post) for each muscle. the collagen content of VL was similar between pre and post in the BRE group (-3.8 μg collagen/mg protein [95% CI: -22.0; 14.4], p=0.68) while it rose amongst individuals in the BR group (14.9 μg collagen/mg protein [95% CI: -0.01; 29.7], p=0.05). The difference of 18.66 [95% CI: -6.5; 43.9] between BRE and BR across time was, however, not significant (p=0.14). No significant reduction in SOL muscle collagen content was observed from pre to post in the BR group (-9.3 μg collagen/mg protein [95% CI: -24.9; 6.4], p=0.25) or in the BRE group (-6.5 μg collagen/mg protein [95% CI: -25.6; 12.6], p=0.50). There was no difference in the effect of BR versus BRE over time (mean difference -2.78 μg collagen/mg protein [95% CI: -29.7; 24.1], p=0.82). muscle collagen content in the VL or SOL muscle does not seem to differ after a 90-day bed rest period with or without squat exercises.

77.: Uncovering the therapeutic mechanism of blood patching for treatment of spontaneous cerebrospinal fluid leaks

The mechanism of action for lumbar blood patches affecting a therapeutic response in a proximal cerebrospinal fluid (CSF) leak is thought to be via a tamponade effect. However, our case study reveals that blood products reach and pool at the site of a proximal CSF leak in the cervical spine – therefore we hypothesise that the therapeutic response results from a combination of a tamponade effect and blood products forming a localised clot in the proximal cervical region. We present a 41-year-old woman with a 12 month history of headache from postural hypotension. The patient’s general practitioner ordered a CT scan of the brain and lumbar spine as part of a workup which revealed that the patient had a cervical spine CSF leak. Subsequent MRI confirmed the CSF leak and intracranial hypotension. A 25 ml epidural blood patch was performed in the lumbar region together with conservative measures including a period of strict bed rest for days with increased hydration and caffeine intake. The patient reported an immediate symptomatic improvement following blood patching with a reduction in headaches. Subsequent imaging revealed resolution of the intracranial hypotension. We followed up the patient with serial MRI scans. These revealed blood reaching and pooling around the site of the CSF leak in the cervical spine. The current case report demonstrates that a lumbar epidural injection of blood reaches and pools around a CSF leak as far proximally as the cervical region. This supports the “plug” theory as the mechanism for persistent symptom resolution. However, the mechanism of immediate symptomatic improvement may still involve a tamponade effect. This two stage process appears to be the best explanation for the therapeutic response obtained from epidural blood patching on the basis of the available clinical, imaging and experimental data.

A mobility program for an inpatient acute care medical unit.

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Effects of 60-day head-down bed rest on osteocalcin, glycolipid metabolism and their association with or without resistance training.

Bone loss and subclinical diabeteslike are developed during long-term spaceflight. Recently, it was demonstrated that bone was able to regulate energy metabolism and testosterone synthesis via osteocalcin. The aim of this study was to determine whether serum osteocalcin level is associated with glycolipid metabolism or testosterone under the influence of microgravity with or without resistive vibration exercise (RVE). A total of 14 healthy adult male volunteers (25-40years) were randomly assigned to two groups (n=7 each): control (CON) group and RVE group. Radioimmunoassay kits and ELISA kits were used for measurement of serum indices. During 60-day bed rest, serum osteocalcin of both groups increased at day 4 during bed rest. Serum OPG started decreasing and reached its lowest value at day 30 during bed rest. In control group, serum insulin increased at day 4 during bed rest. IGF-I did not change significantly during the entire period of bed rest. The serum glucose decline 10% and 14% in CON and RVE groups at day 4 during bed rest. Relatively, the same results as glucose were found in serum HDL and LDL for both groups. Leptin rose and became highest at day 60 during bed rest in both groups. The level of serum testosterone was declined in control group at day 4 during bed rest. Cortisol kept stable in both group during bed rest. By spearman correlation analysis, serum osteocalcin was significantly associated with serum insulin (P<0·05), LDL (P<0·01) and Leptin (P<0·01). Our findings suggested that the mutual regulation may exist between skeletal and energy metabolism under simulated microgravity.

Associations between objectively-measured sedentary behaviour and physical activity with bone mineral density in adults and older adults, the NHANES study

BackgroundLack of physical activity (PA) is an important modifiable risk factor for bone mineral density (BMD). Time spent in sedentary behaviour (SB), or time spent in non-exercising seated and reclining postures, has recently emerged as a new public health risk, independent of the amount of time someone spends being active. As national surveys report that adults spend on average 8h per day being sedentary, rising to 10h a day in older age, it has been hypothesised that a repeated exposure to sitting in modern daily life, whether it is for travelling, working or leisure, might have a deleterious effect on bone health in a way that mirrors the results of studies into the effect of lengthy periods of bed-rest. The aim of this study was to investigate for the first time a) how time spent in SB is associated with bone mineral density (BMD), b) whether this association changes depending on the amount of time spent engaging in different intensity levels of PA, and c) if the pattern of accumulation of SB and long uninterrupted periods of SB are associated with BMD. MethodsThe 2005/2006 National Health and Nutrition Examination Survey (NHANES), is a cross-sectional study of a representative sample of the US population that is conducted biannually by the National Centers for Disease Control. PA and SB were assessed objectively over 7days using an Actigraph accelerometer and BMD was measured via dual-energy X-ray absorptiometry. In this study, data are presented on four regions of the femur (femoral neck, trochanter, inter trochanter and total femur) and total spine (L1–L4). The associations between BMD, SB and PA levels were examined using multiple linear regressions stratified by gender. In addition, the association between the pattern of accumulation of SB (quantified as frequency and duration of SB) and BMD was also investigated. All models were adjusted for known risk factors associated with BMD. In total, data for 2117 individuals, aged 23–90+years (males N=1158), were available to analyse SB and femur BMD and 1942 individuals (males N=1053) for analysis of SB and spine BMD. ResultsThere was no evidence of an association between SB time and hip or spinal BMD in men. For men, time spent doing moderate to vigorous activity (MVPA) and vigorous activity (VIG) was associated with higher total femur and the other hip sub-region BMD. The regression coefficient was BMVPA=0.306 (95% CI: 0.021–0.591)g/cm2 for each 10minute increment in daily MVPA. For VIG, the regression coefficient is BVIG=0.320 (95% CI: 0.058–0.583) but this cannot be interpreted linearly as time spent in vigorous activity was square root transformed. In women, SB was negatively associated with total femur BMD and all sub-regions but not MVPA nor VIG. The regression coefficient for total femur BMD was BSB=−0.159 (95% CI: −0.241–0.076)g/cm2 for each 10minute increment spent being sedentary each day. In addition, the duration of SB bouts was deleteriously associated with BMD for the total femur and of other hip sub-regions, but the number of bouts of SB did not have a significant effect. These associations were found to be independent of the amount of MVPA and VIG that women engage in. No associations were found between SB or PA and spinal BMD for either men or women. ConclusionsThese results provide the first evidence that repeated exposure to sitting (SB), measured objectively in daily life, is deleteriously associated with BMD of the total femur and of all hip sub-regions in women, independent of the amount of time women engage in moderate and vigorous activity. This suggests that SB might be a risk factor for bone health in women independent of whether they engage in physical activity. In addition, the duration of SB bouts, rather than their frequency, appears to be deleteriously associated with BMD of the total femur and of all hip sub-regions. Future research should investigate the effect on bone health of interventions which set out to reduce SB and the duration of SB bouts in comparison, and as adjunct, to the promotion of PA. For men, SB is not significantly associated with BMD of the femur or spine and the results appear to confirm that moderate and vigorous activity has a protective effect.

Femoral revision with impaction bone grafting and a cemented polished tapered stem

Biological repair of femoral bone loss using bone impaction grafting. Reconstruction of the centre of rotation of the hip using a cemented stem, the size and offset of which are at the discretion of the surgeon. Femoral implant loosening with bone loss. Infection, neurological disorders, noncompliant patient. Extraction of the loose femoral implant, cortical reconstruction using meshes if required, impaction bone grafting with special instruments, cement fixation of a polished tapered stem. Individualized period of bed rest and limited weight bearing. Impaction bone grafting and a cemented polished stem were used to perform 33femoral reconstructions. After a mean follow-up of 15years, no femoral reconstruction had to be revised. One unrecognized intraoperative fracture healed after nonsurgical treatment, three postoperative femoral fractures healed after plate fixation with the stem left in situ. The average Harris Hip Score improved from 49prior to surgery to 85points thereafter. Kaplan-Meier analysis with femoral revision for any reason as the end point showed a survival rate of 100 %.

Bone metabolism and renal stone risk during bed rest for men and women (257.8)

Bed rest is a model to simulate and study the human physiological adaptations to spaceflight, for example changes in bone metabolism and renal stone formation. On Earth, the incidence of osteoporosis in women is about double that of men while the incidence of stone formation is more likely in men. These sex specific differences lead to logical questions about the existence of sex‐specific effects during spaceflight that can be tested in the bed rest model. In this study, we combined data from five bed rest studies (n=50 men, 24 women) ranging in duration from 14 ‐ 90 days to assess sex differences in bone loss, bone biochemistry, and renal stone biochemistry. Prior to bed rest, men had higher bone mineral density and content (P &lt; 0.001), and excreted 30 % more biomarkers of bone resorption (i.e., collagen crosslinks) and 20 % more calcium per day than did females (P &lt;0.05). These offsets remained throughout the duration of the bed rest periods. Urine renal stone biochemistry was significantly altered for both men and women during bed rest, resulting in men having an increased renal stone risk compared to the general population. Actual renal stone risks in these studies were reduced by maintaining a high amount of fluid intake (&gt;2.5 L/d). These results indicate that overall both men and women are equally affected by the skeletal unloading of bed rest.

Application of Low-Level Laser Therapy Following Coronary Artery Bypass Grafting (CABG) Surgery.

An attack of acute myocardial infarction (MI) poses the threat of great damage to cardiac tissue. Operative therapeutic modalities such as coronary artery bypass grafting (CABG) may enhance myocardial perfusion in high-grade coronary vasculature occlusions. It has been shown previously that Low-Level Laser Therapy (LLLT) significantly reduces infarct size following induction of myocardial infarction in rats and dogs. The aim of this study was to investigate the effects of LLLT on cardiac tissue healing markers following grafting operations for coronary vessel occlusion. Thirty-two cases having each two or three coronary vessel occlusions (2VD/3VD) underwent low-level laser therapy post-CABG, and 28 patients who did not undergo laser therapy were studied as a control group. Diode laser (810 nm, 500 mW) was used as LLLT protocol for 3 successive days post-CABG. Repeated measurements of blood cell count (CBC) and cardiac damage markers (CPK, CPK-MB, LDH) attained before CABG and during the 5 days of LLLT post-operatively, taken at one and 12 hours after daily laser irradiation. In a comparison of the mean levels of the control and laser group, the variables were statistically different on 5(th) day after intervention for WBC, Neutrophil and Lymphocyte counts and WBC and lymphocyte changes. A statistically significant difference was seen in changes of CPK, CPK-mb and LDH over time P<0.001. It is concluded that low-level laser irradiation after CABG surgery could decrease cardiac cellular damage and help accelerate the repair of cardiac tissue post-operatively. This may lower post-operative disability as well as bed rest period in these patients.

Effect of Positioning on Patient Outcomes After Coronary Angiography

Restoring patient homeostasis after coronary angiography, the gold standard diagnostic test for coronary heart disease is usually achieved by manual compression of the puncture site using a sandbag and prolonged bed rest. However, this process frequently results in patient complaints of back pain and discomfort. The aim of study was to assess the effect of positioning on patient outcomes after coronary angiography. This study used a single-blind randomized control trial approach. The sample consisted of 80 patients who had undergone a nonemergency coronary angiography via the femoral artery. Balanced block randomization was used to allocate participants into intervention and control groups. Routine care for the intervention group (n = 40) was adjusted to include the following: (1) intermittent changes to patient body and head position in bed during first 6 hours after catheterization, (2) reduction of sandbag compression time on the puncture site to 1 hour, and (3) regular examination for bleeding during the first 6 hours after catheterization. Intervention group participants were allowed to ambulate without restriction 6 hours after catheterization. Patients in the control group (n = 40) received routine care, consisting of (1) 6-24 hours of bed rest in the supine position with the affected leg fixed straight and immobilized and (2) sandbag compression on the puncture site for 6 hours. The main outcomes used in this study were level of back pain, discomfort, foot pain, bleeding, and hematoma. Intervention group patients had significantly less back pain and foot pain and higher comfort than the control group at the second, third, and sixth hour after catheterization (p = .00). There was no significant difference between the two groups in terms of amount of bleeding and hematoma (p > .05). Findings suggest that changes in patient position may be safer in the early period of postcatheterization bed rest than currently indicated in standard practice protocols. Furthermore, limiting sandbag compression to 1 hour has no measurable effect on the incidence and severity of vascular complications.

The Effects of Position Change on Low Back Pain, Discomfort, and Bleeding after Transarterial Chemoembolization

Purpose: This study was to test the effects of the positional change on low back pain, discomfort, and bleeding complications during the period of bed rest following transarterial chemoembolization (TACE). Methods: The research design for this study was a non-equivalent control group quasi-experimental design. The participants were 23 patients for the experimental group, and 23 patients for the control group. The experimental group received positional change of taking the semi-Fowler's position and the 30-degree lateral position alternatively during the period of bed rest after TACE for 4 hours at one-hour intervals. The control group maintained the supine position continuously during the period of bed rest after TACE. Results: There were statistically significant differences in low back pain and discomfort between the experimental and the control group after intervention. And no significant difference was found in bleeding complication between two groups. Conclusion: The results of the study suggest that the positional change is an effective nursing intervention to reduce low back pain and discomfort without increasing the risk of bleeding after TACE.

Effects of early rehabilitation therapy on patients with mechanical ventilation.

For patients in intensive care unit (ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation. A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test. There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group (P>0.05). Patients in the rehabilitation group had shorter days to first out of bed (3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation (5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay (12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group. Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

Pulmonary embolism after coronary angiography with femoral approach

Cardiologia CROATICA Objectives: Pulmonary embolism after elective coronary angiography is a very rare complication. Herein we report on a case of pulmonary embolism after diagnostic coronary angiography with femoral approach, and we also evaluate various pathophysiologic mechanisms possibly contributing to local vascular complications and also consequently safer and more efficient approaches for percutaneous coronary procedures. Case report: A 66 year-old female patient was admitted to our department for diagnostic coronary angiography due to high clinical suspicion for coronary artery disease. Coronary angiography was performed with the right common femoral artery access, and no coronary artery stenosis was verified on the examination. Although all the standard postangiography procedures were applied and hemostasis completed, subsequently an access site hematoma and a pseudoaneurysm developed. The day after the procedure, during verticalization, the patient complained of malaise, nausea and vertigo, and due to a high level of D-dimers, we performed MSCT angiography which confirmed pulmonary embolism (Figure 1). The doppler ultrasound of the lower extremity veins showed no signs of deep venous thrombosis, and we have not discovered any predisposing factors for pulmonary embolism. Discussion: Pulmonary embolism is rarely reported as a consequence of coronary angiography with femoral approach, probably since it is underdiagnosed considering its frequent asymptomatic course. Predisposing factors for deep venous thrombosis and pulmonary embolism with the femoral approach for coronary angiography are manual compression of the puncture site with unintentional compression of the femoral vein, compression with the sandbag and a gauze, puncture site hematoma or a femoral artery pseudoaneurysm, along with prolonged immobilization and bed rest. Conclusion: We assume that the cause of pulmonary embolism in our patient was transient deep venous thrombosis due to a combination of puncture area compression, hematoma and a femoral pseudoaneurysm with immobilization and postprocedural bed rest. Optimal placement of the arterial sheath, use of smaller sheaths, careful manual compression with shorter period of immobilization and bed rest, can significantly contribute to reducing the incidence of deep venous thrombosis and pulmonary embolism.

Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?

Introduction. An accidental durotomy is a recognised and not infrequent complication of lumbar spine surgery, and may lead to postoperative low-pressure headaches, pseudomeningocele and CSF leak. Conventional postoperative management involves a period of flat bed rest. There is no agreement as to the need for and duration of postoperative bed rest. This study aims to determine whether the duration of flat bed rest alters the rate of these complications. Materials and methods. This is a retrospective study. All patients who underwent surgery for degenerative spinal disease between May 2010 and May 2011 were reviewed. All patients who incurred an accidental durotomy and who were repaired using fibrin glue were included in this study. Their notes were reviewed for evidence of complications for a minimum of 12 months after surgery. The following complications were identified: postural headache, pseudomeningocele, CSF leak wound infection, subdural haematoma. Results. Eight hundred and eighty-nine patients underwent lumbar spine surgery. Sixty-one (6.8%) patients suffered an accidental durotomy and were repaired with fibrin glue. Twenty-six patients were mobilised on the first postoperative day, 9 patients on the second, and a further 26 patients were mobilised on the third postoperative day or later. The overall incidence of complications related to the durotomy was 18%. There was no statistical significance between the day of mobilisation and the rate of complication (p = 0.433). Conclusion. A longer period of mandatory bed rest does not decrease the rate of complications. Patients should be mobilised as soon as they can. This could potentially reduce the length of hospital stay and the cost of aftercare.

The physiological response of skin tissues to alternating support pressures in able-bodied subjects

Prolonged mechanical loading can lead to breakdown of skin and underlying tissues which can, in turn, develop into a pressure ulcer. The benefits of pressure relief and/or redistribution to minimise risk have been well documented and these strategies can be provided by employing support mattresses in which internal air pressures can be alternated to minimise the risk of pressure ulcers in patients during prolonged periods of bed-rest. The paper describes the performance of a prototype alternating pressure air mattress (APAM), in terms of its ability to maintain skin viability in a group of healthy volunteers lying in a supine position. In particular, the mattress includes a sacral section supported with alternating low pressure (ALP), with values adjusted to subject morphology, using an in-built pressure sensor. The mattress was supported at four different head of bed (HOB) angles ranging from 0 to 60°. Internal mattress pressures and transcutaneous gas (TcPO2/TcPCO2) tensions at the sacrum and a control site, the scapula, were monitored. Interface pressures were also measured. The sensor was found to be sensitive to the BMI values of the 12 healthy volunteers. In the majority of test conditions the internal support produced sacral TcPO2 values, which either remained similar to those at the scapula or fluctuated at levels providing adequate viability. However in a few cases, associated with a raised HOB angle (≥45°), there was compromise to the skin viability at the sacrum, as reflected in depressed TcPO2 levels associated with an elevation of TcPCO2 levels above the normal range. In all cases, interface pressures at the sacrum rarely exceeded 60mmHg. Although such studies need to be extended to involve bed-bound individuals, the results offer the potential for the development of intelligent APAM systems, whose characteristics can be adjusted to an individual morphology. Such preventive strategies to maintain skin viability at loaded sites will be designed for subjects deemed to be at high risk of developing pressure ulcers.

Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults

Loss of muscle mass due to prolonged bed rest decreases functional capacity and increases hospital morbidity and mortality in older adults. To determine if HMB, a leucine metabolite, is capable of attenuating muscle decline in healthy older adults during complete bed rest. A randomized, controlled, double-blinded, parallel-group design study was carried out in 24 healthy (SPPB ≥ 9) older adult subjects (20 women, 4 men), confined to complete bed rest for ten days, followed by resistance training rehabilitation for eight weeks. Subjects in the experimental group were treated with HMB (calcium salt, 1.5 g twice daily - total 3 g/day). Control subjects were treated with an inactive placebo powder. Treatments were provided starting 5 days prior to bed rest till the end rehabilitation phase. DXA was used to measure body composition. Nineteen eligible older adults (BMI: 21-33; age: 60-76 year) were evaluable at the end of the bed rest period (Control n = 8; Ca-HMB n = 11). Bed rest caused a significant decrease in total lean body mass (LBM) (2.05 ± 0.66 kg; p = 0.02, paired t-test) in the Control group. With the exclusion of one subject, treatment with HMB prevented the decline in LBM over bed rest -0.17 ± 0.19 kg; p = 0.23, paired t-test). There was a statistically significant difference between treatment groups for change in LBM over bed rest (p = 0.02, ANOVA). Sub-analysis on female subjects (Control = 7, HMB = 8) also revealed a significant difference in change in LBM over bed rest between treatment groups (p = 0.04, ANOVA). However, differences in function parameters could not be observed, probably due to the sample size of the study. In healthy older adults, HMB supplementation preserves muscle mass during 10 days of bed rest. These results need to be confirmed in a larger trial.

Comparative study on the period of absolute bed rest of vertebral compression fracture.

ObjectiveAs a conservative treatment of compression fractures, absolute bed rest (ABR) for a certain period has been recommended, but no guideline on the period has yet been established. Considering that a long ABR period may adversely affect patients, the difference in prognosis according to the ABR period was investigated in this study.MethodsA prospective study was conducted who were diagnosed with compression fracture. Groups A and B were put on ABR (one week for group A and two weeks for group B). X-ray images at baseline, 1, 2, 4, and 8 weeks were obtained from both groups, for assessment purposes.ResultsThe compression rates of both groups were no significant difference at baseline, 1, 2, 4, and 8 weeks. The conditions of 25.9% and 21.2% of the subjects deteriorated in groups A and B, showing no significant difference. Between the groups of age and bone mineral densities (BMD), no significant difference was observed in the incidence of deterioration. In terms of complications development including constipation and other Gastrointestinal problems, voiding difficulty, etc., group A reported 57.4%, and group B, 84.8%, showing a significant difference (p-value=0.001).ConclusionNo significant difference in the conservative period was observed between the groups. Group B, however, reported a higher complications development rate than group A. Therefore, a short ABR period may be helpful in the early stage of conservative treatment.

Physical Exercise for Patients Undergoing Allogeneic Haematopoietic Stem Cell Transplantation

Allogeneic haematopoietic stem cell transplantation (allo-HSCT) has been increasingly used in the treatment for malignant and nonmalignant haematopoietic diseases [1], especially owing to the constant advances in treatment technology. This has resulted in reduced morbidity and increased life expectancy [2], with disease-specific 5-year survival rates for this treatment ranging from 5% to 80% [2]. The standard procedure for myeloablative allo-HSCT entails a conditioning regime of high-dose chemotherapy, often in combination with totalbody irradiation, followed by the infusion of stem cells harvested from donor bone marrow or peripheral blood [3]. Currently, complications for patients with haematological malignancies are still frequently reported [4], and allo-HSCT treatments are themselves associated with numerous somatic, psychological, and psychosocial side effects [5]. Complications caused by the transplantation emerge at different stages of the treatment. During the pretransplant (conditioning) phase, side effects of high-dose chemotherapy and/or radiation include nausea, emesis, diarrhoea, loss of hair, cystitis/bladder infection, and mucositis [6]. During the posttransplant phase, complications resulting from graft versus host disease include skin rash, bronchiolitis, nausea, emesis, diarrhoea, and jaundice, which results in weakness [7]. As a result of graft versus host disease and its treatment process, patients are often subjected to prolonged periods of immobilization and bed rest that lead to loss of strength and endurance [8]. In a previous study, we confirmed that transplant patients who stayed in isolation rooms for several weeks exhibited deteriorated physical function [9]. We also showed that allo-HSCT patients had lower quality of life (QOL) as well as deteriorated physical function after transplantation than before transplantation [10]. Over the past few years, the number of studies describing the promising role of physical exercise programs performing as nonpharmacologic adjuvant therapy for patients with cancer has been on the rise. Here, we introduce the effects of physical exercise on the QOL, fatigue levels, psychological function, and physical function of allo-HSCT patients.