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The feasibility of monitoring exercise intensity in mechanically ventilated patients recovering from critical illness in Intensive Care

Black, CJ; (2016) The feasibility of monitoring exercise intensity in mechanically ventilated patients recovering from critical illness in Intensive Care. Doctoral thesis , UCL (University College London). Green open access

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Abstract

Critical illness survivorship is frequently characterised by profound long-term physical and psychological disabilities. These arise as a result of the complex interaction between the patho-physiological e ects of critical illness, clinical interventions and the impact of prolonged bed rest on physical and psychological health. Early rehabilitation in the ICU is an important intervention that can overcome some of the devastating impacts of critical illness on patients and their carers. However, with little or no scienti c basis for its prescription and no validated means of assessing individual patient workload during rehabilitation, a \one-size- ts-all" approach is generally adopted. In contrast, the eld of sports science has an extensive literature base describing the optimisation of individual training programs. This thesis explores the potential translation of key precepts of exercise physiology into the ICU setting in order to quantify the workload during rehabilitation in mechanically ventilated (MV) patients recovering from critical illness. Breath-by-breath-gas-exchange-analysis (BBGEA) is the gold standard for measuring exercise capacity and intensity in non-ventilated individuals. However, validated devices in MV patients are lacking. In this thesis the MedGraphics Ultima, a BBGEA device, was validated in the critical care setting, within the limits of two reference techniques; Douglas bag collection and Deltatrac II. The feasibility of using BBGEA in patients rehabilitating in the ICU and the oxygen cost of this rehabilitation were then investigated. I established that, while this device is an invaluable research tool, it is impractical for day-to-day clinical practice. I further identi ed that the oxygen cost of rehabilitation activities in the ICU is not directly activity-dependent. I then developed two models to generate proxy values of oxygen consumption, during rehabilitation interventions, evaluating their performance with a small validation sample. The huge variations in the exercise load of rehabilitation interventions between and within patients highlights the need to establish personalised exercise regimens.

Type: Thesis (Doctoral)
Title: The feasibility of monitoring exercise intensity in mechanically ventilated patients recovering from critical illness in Intensive Care
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: http://discovery.ucl.ac.uk/id/eprint/1476989
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