| Summary: | Background: Patients in Pediatric Intensive Care Units (PICU) face high stressors. The autonomic nervous system (ANS) plays an important role in modulating stress and inflammatory responses. Excess stress reaction includes SNS over-stimulation and PNS suppression. If prolonged, this situation may be source of severe acute and chronic inflammation. Massage therapy is a noninvasive intervention that may regulate stress-induced ANS dysfunction by stimulating PNS and decreasing SNS responses; therefore, acting toward homeostasis.
Objectives: Primary objective was to assess the massage effect on rebalancing the ANS function (measured by Heart Rate Variability, HRV). Secondary objective was to investigate the correlation between HRV and clinical severity (measured with Pediatric Logistic Organ Dysfunction (PELOD) Scores). Pilot study objective was to determine study feasibility.
Methods: All PICU patients were eligible for the study. 22 patients were randomly allocated into one or six massage sessions per day (30-min per session). HRV was extracted from PICU central station. Clinical information was collected from medical records. Descriptive statistics and graphs were used. Study feasibility (problems and solutions) was also assessed.
Results: 18 subjects were included in the analyses. logHF and logLF increased significantly during the first massage session compared to baseline values (p<0.05). HF increased by a mean of 75.06% (95% CI: 19.9~130.23%, p=0.01) and LF increased by a mean of 56.3% (95% CI: 20.31~92.29 %, p=0.004) during the first massage session; although HF and LF decreased in four subjects. After massage the increases in both HF and LF were not significant. LF/HF ratio, when out of the normal range, converged toward normal values during massage. In the six massage sessions (n=7), HF and LF increased in the initial three sessions and plateaued in the remaining sessions. There was a positive relationship between HRV and clinical severity. Study feasibility analysis led us identifying problems and finding solutions.
Conclusion: ANS dysfunction was correlated with clinical severity. Massage therapy had an effect in improving ANS function with increasing PNS and decreasing SNS activities in PICU patients. The optimal number of massage sessions seemed to be three. However, massage could also be a stress for some patients in certain conditions.
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