Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial.

Eggmann, Sabrina; Irincheeva, Irina; Luder, Gere; Verra, Martin L.; Moser, André; Bastiaenen, Caroline H G; Jakob, Stephan M. (2022). Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial. PLoS ONE, 17(2), e0262779. Public Library of Science 10.1371/journal.pone.0262779

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Early rehabilitation is indicated in critically ill adults to counter functional complications. However, the physiological response to rehabilitation is poorly understood. This study aimed to determine the cardiorespiratory response to rehabilitation and to investigate the effect of explanatory variables on physiological changes during rehabilitation and recovery.


In a prospectively planned, secondary analysis of a randomised controlled trial conducted in a tertiary, mixed intensive care unit (ICU), we analysed the 716 physiotherapy-led, pragmatic rehabilitation sessions (including exercise, cycling and mobilisation). Participants were previously functionally independent, mechanically ventilated, critically ill adults (n = 108). Physiological data (2-minute medians) were collected with standard ICU monitoring and indirect calorimetry, and their medians calculated for baseline (30min before), training (during physiotherapy) and recovery (15min after). We visualised physiological trajectories and investigated explanatory variables on their estimated effect with mixed-effects models.


This study found a large range of variation within and across participants' sessions with clinically relevant variations (>10%) occurring in more than 1 out of 4 sessions in mean arterial pressure, minute ventilation (MV) and oxygen consumption (VO2), although early rehabilitation did not generally affect physiological values from baseline to training or recovery. Active patient participation increased MV (mean difference 0.7l/min [0.4-1.0, p<0.001]) and VO2 (23ml/min [95%CI: 13-34, p<0.001]) during training when compared to passive participation. Similarly, session type 'mobilisation' increased heart rate (6.6bpm [2.1-11.2, p = 0.006]) during recovery when compared to 'exercise'. Other modifiable explanatory variables included session duration, mobilisation level and daily medication, while non-modifiable variables were age, gender, body mass index and the daily Sequential Organ Failure Assessment.


A large range of variation during rehabilitation and recovery mirrors the heterogenous interventions and patient reactions. This warrants close monitoring and individual tailoring, whereby the best option to stimulate a cardiorespiratory response seems to be active patient participation, shorter session durations and mobilisation.


German Clinical Trials Register (DRKS) identification number: DRKS00004347, registered on 10 September 2012.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Irincheeva, Irina, Verra, Martin, Moser, André, Jakob, Stephan


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Public Library of Science




Doris Kopp Heim

Date Deposited:

14 Feb 2022 10:54

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


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