Pierre Maffei1, Sandrine Wiramus2, Laurent Bensoussan1, Laurence Bienvenu1, Eric Haddad1, Sophie Morange3, Mohamed Fathallah3, Jean Hardwigsen4, Jean-Michel Viton1, Y Patrice Le Treut4, Jacques Albanese2, Emilie Gregoire5. 1. Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Department of Physical Medicine and Rehabilitation, Hôpital de la Conception, Marseille, France. 2. Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Intensive Care Department, Hôpital de la Conception, Marseille, France. 3. Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Clinical Evaluation Unit, Hôpital de la Conception, Marseille, France. 4. Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Department of General Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France. 5. Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille, Department of General Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France. Electronic address: emilie.gregoire@ap-hm.fr.
Abstract
OBJECTIVE: To validate the feasibility and tolerance of an intensive rehabilitation protocol initiated during the postoperative period in an intensive care unit (ICU) in liver transplant recipients. DESIGN: Prospective randomized study. SETTING: ICU. PARTICIPANTS: Liver transplant recipients over a period of 1 year (N=40). INTERVENTIONS: The "usual treatment group" (n=20), which benefited from the usual treatment applied in the ICU (based on physician prescription for the physiotherapist, with one session a day), and the experimental group (n=20), which followed a protocol of early and intensive rehabilitation (based on a written protocol validated by physicians and an evaluation by physiotherapist, with 2 sessions a day), were compared. MAIN OUTCOME MEASURES: Our primary aims were tolerance, assessed from the number of adverse events during rehabilitation sessions, and feasibility, assessed from the number of sessions discontinued. RESULTS: The results revealed a small percentage of adverse events (1.5% in the usual treatment group vs 1.06% in the experimental group) that were considered to be of low intensity. Patients in the experimental group sat on the edge of their beds sooner (2.6 vs 9.7d; P=.048) and their intestinal transit resumed earlier (5.6 vs 3.7d; P=.015) than patients in the usual treatment group. There was no significant difference between the 2 arms regarding length of stay (LOS), despite a decrease in duration in the experimental group. CONCLUSIONS: The introduction of an intensive early rehabilitation program for liver transplant recipients was well tolerated and feasible in the ICU. We noted that the different activities proposed were introduced sooner in the experimental group. Moreover, there is a tendency to decreased LOS in the ICU for the experimental group. These results now need to be confirmed by studies on a larger scale.
RCT Entities:
OBJECTIVE: To validate the feasibility and tolerance of an intensive rehabilitation protocol initiated during the postoperative period in an intensive care unit (ICU) in liver transplant recipients. DESIGN: Prospective randomized study. SETTING: ICU. PARTICIPANTS: Liver transplant recipients over a period of 1 year (N=40). INTERVENTIONS: The "usual treatment group" (n=20), which benefited from the usual treatment applied in the ICU (based on physician prescription for the physiotherapist, with one session a day), and the experimental group (n=20), which followed a protocol of early and intensive rehabilitation (based on a written protocol validated by physicians and an evaluation by physiotherapist, with 2 sessions a day), were compared. MAIN OUTCOME MEASURES: Our primary aims were tolerance, assessed from the number of adverse events during rehabilitation sessions, and feasibility, assessed from the number of sessions discontinued. RESULTS: The results revealed a small percentage of adverse events (1.5% in the usual treatment group vs 1.06% in the experimental group) that were considered to be of low intensity. Patients in the experimental group sat on the edge of their beds sooner (2.6 vs 9.7d; P=.048) and their intestinal transit resumed earlier (5.6 vs 3.7d; P=.015) than patients in the usual treatment group. There was no significant difference between the 2 arms regarding length of stay (LOS), despite a decrease in duration in the experimental group. CONCLUSIONS: The introduction of an intensive early rehabilitation program for liver transplant recipients was well tolerated and feasible in the ICU. We noted that the different activities proposed were introduced sooner in the experimental group. Moreover, there is a tendency to decreased LOS in the ICU for the experimental group. These results now need to be confirmed by studies on a larger scale.
Authors: C Hobeika; F Cauchy; E Weiss; S Chopinet; A Sepulveda; F Dondero; L Khoy-Ear; B Grigoresco; S Dokmak; F Durand; B Le Roy; C Paugam-Burtz; O Soubrane Journal: BJS Open Date: 2021-01-08
Authors: Esperidião Elias Aquim; Wanderley Marques Bernardo; Renata Ferreira Buzzini; Nara Selaimen Gaertner de Azeredo; Laura Severo da Cunha; Marta Cristina Pauleti Damasceno; Rafael Alexandre de Oliveira Deucher; Antonio Carlos Magalhães Duarte; Juliana Thiemy Librelato; Cesar Augusto Melo-Silva; Sergio Nogueira Nemer; Sabrina Donatti Ferreira da Silva; Cleber Verona Journal: Rev Bras Ter Intensiva Date: 2019 Oct-Dec