Tolerance of very early exercise in intensive care unit based on a decisional algorithm: A pilot feasibility study

Abstract

Practice guidelines recommend early physical therapy in intensive care unit (ICU) [1] . We aimed to evaluate the tolerance of an early exercise program in ICU based on a decisional algorithm issued from the evidence based data and an experts opinion. In this pilot feasibility study, main outcome collected before and after exercise session is discomfort on a Visual Analogue Scale (VAS discomfort ). Secondary outcomes are muscle strength (Medical Research Council scale), length of stay on ICU, mortality in ICU and place for discharge destination. The standardized program includes an upper and lower limbs (LL) training (cycloergometer for LL and manual range of motion) and a functional training, delivered by a physical therapist. The progression is based on fixed VAS discomfort threshold at 7/10 during exercise and on algorithm constructed from a systematic review of literature [2] , using the Consort recommendations and the PEDro grid. Thirty patients were recruited, a total of 150 training sessions were made daily and overall tolerance of an early exercise program in ICU, based from an algorithm applied to the ICU patients is good. We confirm the feasibility of such programs and the very few benign adverse events rate. We note a low incidence of polyneuromyopathy diagnosis. Tolerance of an early exercise program in ICU based from an algorithm is good, but these preliminary results remain to be confirmed in a prospective randomized controlled trial. However, the use of this decisional algorithm should be encouraged to standardize and to initiate progressively very early exercise programs in ICU.