Hydrotherapy+in+cri/cally+ill++ven/lated+pa/ents:++a"mixed(methods"study."

Karin"M."Felten(Barentsz,"PT,"MSc."Radboud"University"Medical"Center"Nijmegen,"The"Netherlands"

Disclosures+

(student)"counseling"

travel"fee"

HYDROTHERAPY POOL & ADJUSTABLE FLOOR SPECIALIST

Introduc/on+""

•  Early"mobilizaIon"pracIce""

•  High(tech"swimming"pool"Radboudumc""•  Hydrotherapy"(HT)"is"feasible"and"safe""

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→ FuncIonal"recovery"process?"→ Mental"and"psychological"effects?"

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Feasibility+and+Safety+of+Hydrotherapy+in+Cri/cally+Ill+Ven/lated+Pa/ents+"

American"Journal"of"Respiratory"and"CriIcal"Care"Medicine""Volume%191%Number%4%|%February%15%2015%"

Aim+""

To"gain"insight"in"the"recovery"process"and"paIent"experiences"of"criIcally"ill"venIlated"paIents""

treated"with"hydrotherapy."""""""""""""""

Methods+A+sample++

•  RetrospecIve"observaIonal"mixed(methods"design"•  Convenience"sample"

•  Inclusion"criteria:""•  Mechanical"venIlaIon"(MV)"at"first"HT"session"•  Expected"duraIon"MV">"7"days"•  Hemodynamic"and"neurological"stable"•  CooperaIve""

•  Exclusion"criteria:"•  Wounds""•  Drainage"systems"•  Flexi(seal"•  MulI(resistant"bacteria"

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Methods+A+data+collec/on+

•  Data"collecIon:"•  T0"(at"first"HT"session)"•  T1"(a\er"2"weeks)"•  T2"(a\er"4"weeks)"•  T3"(a\er"6"weeks)"•  T4"(a\er"12"weeks)""+"Semi(structured"interviews"""

•  Primary"outcome:""De"Morton"Mobility"Index""""""""""""""""(DEMMI)"

Methods+A+analysis""

•  PaIent"characterisIcs"

•  CharacterisIcs"of"HT"sessions """"""DescripIve"staIsIcs"

•  FuncIonal"outcome"measures"

" " ""

•  QualitaIve"interviews " """"Phenomenological"approach"""""""""""""""

Methods+A+Hydrotherapy+

Results+A+pa/ent+characteris/cs+

Characteris/c+ N=11+

Age,"median"(range)" 69"(33"("80)"""

Body+Mass+Index,+median"(range)" 28"(17"("30)"

Reason+for+ICUAadmission+(N)"Lung"disease"""""""""""""""Cardiac"surgery""""""""""Abdominal"surgery""""Trauma""""""""""""""""""""""""OOH"ResuscitaIon"+

"N="5"(46%)"N="3"(27%)"N="1"(9%)"N="1"(9%)"N="1"(9%)"

ICU+length+of+stay+in+days,+median"(interquarIle"range)" 22"(6.7"("28.2)"

Dura/on+of+MV+in+days,"median"(interquarIle"range)" 22"(6"("32)"

Hospital+length+of+stay+in+days,+median"(interquarIle"range)"

49"(34.3"("74.1)"

Mortality(N)" N="3"(27%)"

Results+A+hydrotherapy+sessions+

0"

1"

2"

3"

4"

5"

6"

7"

8"

9"

10"

1" 2" 3" 4" 5" 6" 7" 8" 9" 10" 11"

Number"of"sessions"

PaIent"number"

HT+sessions+Characteris/c+ N=55+

Arterial+catheter" 3,6%""

Covered+wounds+ 27%"

Mechanical+ven/la/on+ 31%"

Tube,+Tracheostomy,+None+ 4%,"85%,"11%"

Complica/ons+ 0"

Number+of+staff+in+the+water,+modus"(range)" 1"(1(2)"

Number+of+persons+during+HT+session,+modus"(range)" 3"(2(7)"

Type+of+exercises:+("Movements"in"supine"posiIon"("Swimming"(back"stroke)""("Seated"posiIon"("Standing"posiIon"("Walking"

"28%"79%"60%"77%"53%"

Walking+distance+(m),+mean"(range)" 9.5"(0"("50)"

Time+spend+in+the+water+(min),+mean"(range)+ 31"(20"("45)"

Results+A+primary+outcome+

0"10"20"30"40"50"60"70"80"90"

100"

Inclusion" 2"weeks" 4"weeks" 6"weeks" 12"weeks"

DEMMI(score"

Measurement"Ime"

Results+A+qualita/ve+interviews+"

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PosiIve"experiences:"

•  Feeling"safe"in"the"water"

•  Being"able"to"move"

•  Experiencing"a"turning"point"

•  Special"appreciaIon"towards"hydrotherapy"

NegaIve"experiences:"

•  Experiencing"the"consequences"of"criIcal"illness"

""""""""""""""

“Even"my"wife"went"along"into"the"water."And"the"therapist."That"really"gave"me"a"safe"feeling.”""

“Your"body"has"let"you"down,"that"is"how"you"feel"at"that"point.”""

“I"was"so"weak,"I"just"sank"through"my"legs."In"the"pool"I"didn’t"have"that"at"all,"I"could"stand"and"walk!”""

“Body"and"mind,"for"both"it"was"just"good."Swimming"really"gave"me"a"boost.”"

“If"you"ask"me:"swimming"should"be"done"every"day.”"

Conclusion+

•  Recovery"process"of"11"paIents"treated"with"HT"" "!"Design"a"controlled"intervenIon"study"" "!"Larger"study"populaIon"

"•  The"content"of"the"treatment"sessions"" "!"Could"be"used"by"other"hospitals"to"copy"treatment"" "!"Cost"effecIveness?"

"•  The"way"paIents"experience"HT"

"!"Encouragement"to"conInue"HT"treatment""

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"Acknowledgement: """Roel"G.A.M."van"Oorsouw,"PT,"MSc"Leo"M."A."Heunks,"M.D.,"Ph.D."Antonius"J."C."Haans,"CNS"MA"ANP"Johannes"G."van"der"Hoeven,"M.D.,"Ph.D."Dr."Bart"Staal,"PT,"Ph.D."Maria".W."Nijhuis(van"der"Sanden,"PT,"Ph.D.""Department"of"Physical"Therapy,"Department"of"RehabilitaIon"and"the"Intensive"Care"Unit,"Radboud"University"Medical"Center,"Nijmegen,""The"Netherlands"""

"""Correspondence"to:"""Karin.Barentsz@radboudumc.nl"

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