Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil.
Department of Medicine, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil.
Int J Cardiovasc Imaging. 2022 Feb;38(2):297-308. doi: 10.1007/s10554-021-02402-0. Epub 2021 Sep 18.
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).
脓毒症是一种严重的器官功能障碍，会导致危重症患者的内皮损伤。从生理学角度来看，在血管血流量增加和切变应力刺激时，血管直径会增大。然而，在面对被动运动（PM）这种早期活动策略时，血管的反应模式在脓毒症患者中尚未得到探索。本研究旨在探讨脓毒症患者 PM 后的血管反应模式及其与临床和心血管特征的相关性。这是一项横断面、单臂研究，共纳入了 32 名被诊断为脓毒症的患者。使用肱动脉超声评估血管反应，在 PM 前后分别进行血流介导的舒张功能（FMD）检测。还计算了 PM（评估反应模式）和 SR（切变率）。PM 方案包括膝关节、髋关节、手腕、肘部、肩部、背屈/跖屈运动，每个部位重复 3 次×10 次（15 分钟）。通过 Sphygmocor®评估动脉僵硬度，通过分析形态和脉搏波速度。通过分析心率变异性指数（平均 HR、RMSSD、LF、HF、ApEn、SampEn、DFA）评估心脏自主神经调节（CAM）。PM 后观察到不同的血管反应：（1）血管直径增加（反应者）（n=13，%FMD=11.89±5.64）和（2）血管直径减小（无反应者）（n=19，%FMD=-7.42±6.44）。反应者的非线性 DFA2 指数较高（p=0.02）。FMD 与 DFA 呈正相关（r=0.529；p=0.03）；FMD 与 SampEn（r=0.633；p<0.01）。FMD 与 LF（Hz）（r=-0.680；p<0.01）和 IL-6（r=-0.469；p=0.037）呈负相关，SR 与 CRP（r=-0.427；p=0.03）呈负相关。
