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Volume 3
Journal of Physiotherapy & Physical Rehabilitation
Physicians 2018
August 15-16, 2018
August 15-16, 2018 Tokyo, Japan
8
th
World Physiotherapists and Physicians Summit
Can early physical rehabilitation modulate underlying pathological mechanisms in critical illness?
Kayambu Geetha
National University Hospital, Singapore
C
ritical care management is multi focal which can confound into multiple pathologies requiring multiple pathways of
recovery. An estimated 2% to 11% of critically ill patients require prolonged stays in the ICU accounting for 25-45% of
total ICU days. Acute muscle wasting is directly correlated with systemic inflammation during critical illness and patients with
multi-organ failure can suffer muscle loss of more than 15% by the end of the first week of ICU admission. In addition, oxidative
stress caused during the disease process is an atrophic stimulus in unloaded muscle that promotes atrophy by modifying
redox-sensitive processes in the muscle fibers. Preservation of muscle mass should focus on anabolic restoration through early
physical rehabilitation strategies however anabolic and catabolic pathways have not been explored in detail up to date. Through
targeted exercise, the prevention of excessive release of pro-inflammatory cytokines and activation of proteolytic pathways
leading to limitation of free-radical generation may inhibit the catabolic skeletal muscle changes in severe critical illness.
Progressive physical activity may also reduce resting CRP (C-Reactive Protein) levels through multiple mechanisms, causing
a decrease in cytokine production and possibly impose an antioxidant effect. Different exercise protocols can result in varying
levels of ROS (Reactive Oxygen Species) production, as oxidative damage can be both intensity and duration dependent.
However, the oxidative stress responses of early physical rehabilitation during disease states are yet to be explored. The overall
aim is to evaluate the capacity of early exercise to modulate pathological outcomes during critical illness. It is hypothesized that
early exercise alters underlying pathological mechanisms of critical illness; inflammation, illness severity, microcirculation and
oxidative processes affecting muscle architecture. Preliminary evidence suggests that early exercise can modify fat free muscle
mass and inflammatory biomarkers in critically ill patients. The physiological reasons for improvement or adverse effects on
underlying pathology of critical illness with early exercise require further investigations.
geetha_kayambu@nuhs.edu.sgPhysiother Rehabil 2018, Volume 3
DOI: 10.4172/2573-0312-C2-006