title: Effects of Early Bedside Cycle Exercise on Intracranial Pressure and Systemic Hemodynamics in Critically Ill Patients in a Neurointensive Care Unit.
abstract: Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU).
  
  
  
  Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital. One early implemented exercise session was performed using a bedside cycle ergometer for 20 min. Intracranial and hemodynamic variables were measured two times before, three times during, and two times after the bedside cycling exercise. Analyzed variables were intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The cycling intervention was conducted within 7 ± 5 days after admission to the NICU.
  
  
  
  Cycle exercise increased MAP (p = 0.029) and SV (p = 0.003) significantly. After exercise CO, SV, MAP, and CPP decreased significantly, while no changes in HR, SVV, SpO2, or ICP were noted when compared to values obtained during exercise. There were no differences in data obtained before versus after exercise.
  
  
  
  Early implemented exercise with a bedside cycle ergometer, for patients with severe brain injuries or stroke when admitted to a NICU, is considered to be a clinically safe procedure.
authors.affiliation: Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden. anneli.thelandersson@vgregion.se.|Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden. anneli.thelandersson@vgregion.se.
authors.forename: Anneli
authors.initials: A
authors.lastname: Thelandersson
authors.affiliation: Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Nellgård
authors.affiliation: Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Ricksten
authors.affiliation: Institute of Physiology and Neuroscience, Department of Health and Rehabilitation/Physiotherapy, Gothenburg University, Gothenburg, Sweden.|Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Cider
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000379:methods; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000628:therapy*
keywords: Cardiac output; Cerebral perfusion pressure; Continuous passive motion; Intensive care; Intracranial pressure; Passive exercise; Physiotherapy