Acute Hemodynamic Changes Induced by Physiotherapy in Critically Ill Patients: A Prospective Observational Study

Background: The potential benefits of safe physiotherapy are immense, which may mitigate the devastating functional impairments caused by critical illness. However, there is sparse data on its safety with respect to hemodynamic changes, including the level of vasopressor therapy at which physiotherapy is deemed safe. Materials and methods: The hemodynamic parameters were recorded before, after, and every 5 minutes during physiotherapy in a total of 107 patients. Cardiac output was measured by Doppler ultrasound. Based on the type of physiotherapy, the study participants were grouped into active and passive groups. The frequencies of predefined adverse events were captured. Results: Of the 107 study participants, 65 received active physiotherapy (Group I) and 42 passive physiotherapy (Group II), with 29% on noradrenaline infusion. There was an increasing trend in each of the hemodynamic parameters after physiotherapy, as compared to rest. The mean changes in parameters before and after physiotherapy were heart rate 6.04/min; respiratory rate 3.9/min; systolic blood pressure 5 mm Hg; diastolic blood pressure 3.3 mm Hg; mean arterial pressure 3.4 mm Hg, cardiac output 0.752 L/min; and SpO2 0.44%. Despite being statistically significant, the small changes after physiotherapy lack clinical significance. Subgroup analysis between the active and passive physiotherapy groups was also done. The incidence of adverse events was 10.2%. Conclusion: Physiotherapy may be well tolerated in critically ill patients, even when there is a requirement for vasopressor support. Transient hemodynamic changes likely reflect physiological compensation for increased oxygen demand during physiotherapy, with low adverse event rates highlighting its safety in the intensive care unit (ICU).