Diferentes padrões de resposta vascular à mobilização passiva em pacientes com sepse: investigação do perfil clínico e cardiovascular dos pacientes respondedores e não respondedores
Kawakami, Débora Mayumi de Oliveira
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Background: Sepsis is a serious organ dysfunction that leads to endothelial damage. Passive mobilization (PM) results in increased blood flow and shear stress. Increased vascular diameter has been observed as a response to physical exercise, although it has not yet been explored in patients with sepsis. Objective: To explore patterns of vascular response to PM and seek associations with the clinical profile, cardiac autonomic modulation (CAM) and arterial stiffness in patients with sepsis. Methodology: Cross-sectional, single-arm study. Were included 32 patients diagnosed with sepsis. The PM protocol consisted of dorsiflexion / plantar flexion movements, knee / hips flexion / extension, wrists and elbows and shoulder flexion in 3x10 repetitions, with an interval of 15 seconds between sets and 30 seconds between joints (totaling = 12 minutes). Vascular response was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound, with the FMD being obtained before and after PM. The Δ PM (to assess the response pattern) and SS (shear stress) were also calculated. Arterial stiffness was assessed by Sphygmocor®️, by analyzing the morphology and pulse wave velocity. The MAC was assessed by analyzing heart rate variability in the time domain (mean HR and RMSSD), frequency (LF, HF) and non-linear (ApEn, SampEn, DFA). Results: Different vascular responses were observed: 1. Increased vascular diameter (responders) (Δ% DMF = 11.89 ± 5.64) and 2. reduction in vascular diameter (non-responders) (Δ% DMF = -7.42 ± 6.44). Responders had a higher Alpha 2 index (p = 0.02). A positive association was identified between ΔFMD and Alpha 2 (r = 0.529; p = 0.03) and SampEn (r = 0.633; p <0.01) and a negative association between ΔFMD and LF (Hz) (r = -0.680; p <0.01) and IL-6 (r = -0.469; p = 0.037). Additionally, a negative association was observed between ΔSS and CRP (r = -0.427; p = 0.03). Conclusion: Patients with sepsis present different patterns of vascular reactivity in relation to passive mobilization. The increased vascular diameter pattern was associated with greater complexity of the autonomic nervous system and inversely related to sympathetic modulation and inflammatory profile.
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