PTCase SeriesJournal of physical therapy science2017

Passive exercise of the lower limbs and trunk alleviates decreased intestinal motility in patients in the intensive care unit after cardiovascular surgery.

Tomoyuki Morisawa, Tetsuya Takahashi, Naoki Sasanuma and 7 others

PMID 28265164

WHAT IT FOUND

In ICU patients after cardiovascular surgery, passive leg and trunk movements briefly increased bowel-sound activity and the number of bowel sounds heard.

Heart rate, blood pressure, and breathing rate stayed similar. It did not show real bowel function improved.

Key findings

01Passive exercise of the lower limbs and trunk increased recorded bowel-sound activity and the number of bowel sounds heard.

02Bowel-sound activity increased significantly in the minute after exercise and in minutes up to four minutes after exercise.

03Heart rate, systolic blood pressure, and respiratory rate did not change significantly, and no passive exercise session was stopped.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

Only 10 patients were studied, all from one hospital and after cardiovascular surgery, so the result may not apply to other ICU patients. There was no control group or usual-care comparison, so the change after exercise cannot be separated from time, position, or routine ICU care. The main outcome was bowel sounds measured by an electronic stethoscope, not a clinical bowel outcome such as defecation, feeding tolerance, nausea, or ileus resolution. The authors state that the clinical meaning of increased bowel sounds is unknown. The effect was short-lived, with the strongest change in the first minute after exercise. Patients had to be off sedation, weaned from ventilation, not have ileus, and not have abdominal surgery, so very sick or more sedated ICU patients were excluded.

The easy way to misread this

Do not conclude that passive exercise of the lower limbs and trunk treats postoperative ileus or improves bowel function in ICU patients. The study measured bowel sounds in 10 patients without a control group, and the authors say the clinical meaning of the increase is unknown.

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The study

Participants
10 ICU patients after cardiovascular surgery (4 men, 6 women; median age 70.5 years, range 62-79)
Certainty of evidence
Very low

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Cite

Tomoyuki Morisawa, Tetsuya Takahashi, Naoki Sasanuma, et al. Passive exercise of the lower limbs and trunk alleviates decreased intestinal motility in patients in the intensive care unit after cardiovascular surgery. Journal of physical therapy science. 2017.

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