Chair positioning is one of a series of early mobilization techniques. At present, this technique, which involves moving a patient out of the resuscitation bed, can be performed passively or actively. It does not constitute a rehabilitative act as such, but it is considered in common paradigms as a technique to improve "the patient's breathing and strength".
However, recommendations issued in 2013 by the Society of intensive care physiotherapy and the society "Société de réanimation de langue française (SRLF)", reveal that this chair position cannot be recommended with a high grade.
The aim of the investigators is therefore to break down this early mobilization process in intensive care, to find out whether the armchair is an indispensable tool for improving functional and muscular processes.
The research hypothesis is therefore as follows:
"Early armchairing of the resuscitation patient, improves functional recovery compared to a conservative positioning strategy (sitting in bed)."
Patient > 18 years old
Patient on invasive mechanical ventilation for more than 24 hours
Patient in recovery phase with a RASS score greater than "-3" for more than 12 hours
Stay expected to last 48 hours
Patient with an absolute and non-resolving contraindication to chair positioning
Fracture or orthopedic disorder contraindicating mobilization out of bed
Obesity with body mass index greater than 45 kg/cm2
Sacral eschar stage greater than 2
Parallel
sitting out of bed in an arm-chair position
Other interventionOnce the patient has been awake with a RASS score between -1 and +1 for more than 12 hours, he or she must be placed in a chair (by any means) every day for a minimum of 30 minutes until "discharge" from intensive care (or until D28, depending on which comes first), unless there are transient contraindications. If the patient is unable to signal his or her wish to stop the chair session, the criteria for intolerance will be sought and the patient placed in the chair, but in all cases the chair session will not exceed 4 hours.
Functional level on "discharge" from intensive care
Functional level at "discharge" from the intensive care unit measured by the Physical Function ICU Test scored (PFIT-s). Minimum value = 0 , meaning worse functionnal status Maximum value = 12, meaning better functionnal status
ICU Mobility scale
Maximum level of mobility achieved Minimum value = 0, meaning "no mobility" Maximum value = 10, meaning "walking without assistance"
MRC sum score
Presence of muscular weakness acquired in intensive care Minimum value = 0, meaning "no muscular contraction" Maximum value = 60, meaning "normal muscular force"
Length of stay in intensive care unit
Ventilator free days
Number of days without invasive mechanical ventilation
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