In-bed Cycling Research Articles

Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial.

Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients' short-term physical function. Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (≥65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95% CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (≥65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ≥5 versus <5), and sex (male versus female). CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830. RR1-10.2196/54451.

Characterizing usual-care physical rehabilitation in Canadian intensive care unit patients: a secondary analysis of the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength pilot randomized controlled trial.

Physical rehabilitation (PR) in the intensive care unit (ICU) may improve outcomes for survivors but clinical trial results have been discordant. We hypothesized that discordant results may reflect treatment heterogeneity received by "usual care" comparator groups in PR studies. Usual-care PR is typically underspecified, which is a barrier to comparing results across treatment studies. The primary objective of the present study was to describe the usual-care PR received by critically ill patients enrolled in the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) pilot randomized controlled trial (RCT) of PR. Other objectives were to help contextualize current research and provide data for international comparison. In this secondary analysis of the CYCLE pilot RCT, patients were randomized to in-bed cycling and usual-care PR or usual-care PR alone. Physiotherapists documented usual-care PR including therapy received, type of activity, duration, adverse events and consequences, reasons for no PR, and concurrent relevant medical interventions. We characterized usual care using descriptive statistics at the cohort and patient levels. Across seven Canadian centres, 30 patients were randomized to usual-care PR. The median [interquartile range (IQR)] ICU stay was 10 [9-24] days and patients received PR on a median [IQR] of 5 [3-9] days for 23 [17-30] min per day. Eighteen patients (60%) stood, marched, or walked during usual care. Transient adverse events occurred in three patients on 1.5% (3/198) of days and none prompted session termination. In the usual-care arm of the CYCLE pilot RCT, PR was delivered on half of ICU days and over half of patients stood, marched, or walked. Adverse events during usual-care PR were uncommon. ClinicalTrials.gov ( NCT02377830 ); first posted 4 March 2015.

The effect of in-bed cycling combined with high flow nasal cannula treatment on arterial oxygen and respiratory dynamics in patients with severe respiratory failure: A retrospective study.

To assess the effects of in-bed cycling (IBC) combined with high flow nasal cannula (HFNC) on arterial oxygen and respiratory dynamics in patients with severe respiratory failure (RF). We retrospectively collected clinical data of 103 patients with severe RF, admitted to the intensive care unit (ICU) of The Second Affiliated Hospital of Harbin Medical University from March 2021 to March 2023. Among them, 50 patients had HFNC alone (control group), and 53 patients did IBC in addition to HFNC (observation group). We compared arterial oxygen index, lung function, respiratory dynamics, and clinical efficacy between the two groups. There was no significant difference in the basic data between the two groups (P>0.05). After the treatment, the improvement of the partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2), arterial oxygen saturation (SaO2), and oxygen delivery (DO2) in the observation group was significantly better than that in the control group (P<0.05). After the treatment, the improvement of lung function in the observation group was better than that in the control group (P<0.05). After the treatment, the end expiratory pulmonary pressure (Ptp-ee) and driving pressure (△Ptp) levels in the observation group were significantly higher, and the duration of ICU hospitalization and the incidence of ICU-acquired weakness(ICU-AW) were significantly lower than those in the control group (P<0.05). IBC combined with HFNC can significantly improve arterial oxygen levels, lung function, and respiratory dynamics in patients with severe RF. IBC in combination with HFNC is associated with shorter stay time in the ICU, reduced of ICU-acquired weakness, and better physical recovery of patients.

Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

BackgroundCritical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment.MethodsWe randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function).ResultsCycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, −0.19 to 0.65; P=0.29).ConclusionsAmong adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].)

Standardized In-Bed Mobility Protocol to Increase Functional Outcomes in Pediatric Intensive Care Unit: A Pilot Randomized Controlled Trial

AbstractThe primary aim of this study is to determine whether a standardized in-bed mobility protocol involving an in-bed cycle ergometer in critically ill children increases functional outcomes as measured by the Functional Status Scale (FSS) and dynamometer measurements compared with patients participating in standard rehabilitation care. The secondary aim was to compare hospital length of stay (HLOS) between the two groups. This pilot randomized controlled trial (RCT) was conducted between April 2021 and December 2022. Eligible patients were randomized to the intervention group (up to 30 minutes of daily in-bed cycle ergometer use) or the control group (standardized rehabilitation care). During the study duration, 30 patients were randomized (13 in the control group and 17 in the intervention group). The difference in whole-body muscle strength measurements (enrollment vs. completion of study) was higher in the experimental group (3.68 lbs.) compared with the control group (1.5 lbs.). However, the difference between groups was not statistically significant (p = 0.18). Both the intervention group and the control group showed similar significant improvements in the FSS scores throughout the therapy, with no difference between the two groups. There was a significant positive correlation between exercise time and change in muscle strength (r = 0.75, p = 0.002). No difference in HLOS was detected in the study. Results from this pilot RCT suggest a trend toward benefits from using in-bed cycle ergometers. These devices may be an additional modality for preserving muscle function in critically ill children. Larger multicentric studies are needed for more conclusive evidence.

Effect of Exercise Training on Prognosis in Community-acquired Pneumonia: A Randomized Controlled Trial.

To investigate the effect of standard care (SoC) combined with supervised in-bed cycling (Bed-Cycle) or booklet exercises (Book-Exe) versus SoC in community-acquired pneumonia (CAP). In this randomized controlled trial, 186 patients with CAP were assigned to SoC (n = 62), Bed-Cycle (n = 61), or Book-Exe (n = 63). Primary outcome length of stay (LOS) was analyzed with analysis of covariance. Secondary outcomes, 90-day readmission, and 180-day mortality were analyzed with Cox proportional hazard regression and readmission days with negative-binominal regression. LOS was -2% (95% CI: -24 to 25) and -1% (95% CI: -22 to 27) for Bed-Cycle and Book-Exe, compared with SoC. Ninety-day readmission was 35.6% for SoC, 27.6% for Bed-Cycle, and 21.3% for Book-Exe. Adjusted hazard ratio (aHR) for 90-day readmission was 0.63 (95% CI: .33-1.21) and 0.54 (95% CI: .27-1.08) for Bed-Cycle and Book-Exe compared with SoC. aHR for 90-day readmission for combined exercise was 0.59 (95% CI: .33-1.03) compared with SoC. aHR for 180-day mortality was 0.84 (95% CI: .27-2.60) and 0.82 (95% CI: .26-2.55) for Bed-Cycle and Book-Exe compared with SoC. Number of readmission days was 226 for SoC, 161 for Bed-Cycle, and 179 for Book-Exe. Incidence rate ratio for readmission days was 0.73 (95% CI: .48-1.10) and 0.77 (95% CI: .51-1.15) for Bed-Cycle and Book-Exe compared with SoC. Although supervised exercise training during admission with CAP did not reduce LOS or mortality, this trial suggests its potential to reduce readmission risk and number of readmission days. NCT04094636.

THE EFFECT OF IN-BED LEG CYCLING EXERCISES ON MUSCLE STRENGTH IN PATIENTS WITH INTENSIVE CARE UNIT-ACQUIRED WEAKNESS: A SINGLE-CENTER RETROSPECTIVE STUDY.

To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW). Single-center retrospective study. Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group. The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared. Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001). In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

Short-term effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients: a randomized blinded clinical trial

Background: The effects of in-bed cycling on mobility and muscle strength is not well established, in parts due to the difficulty of measuring mobility. Objective: Investigate the effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients evaluated by the Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Methods: Critically ill patients dependent on mechanical ventilation were randomized, determining the control group and the experimental group. A intervention was applied for eight consecutive days and a blind physiotherapists assessed mobility before and after interventions. The experimental group (EG) was an active lower limb in-bed cycle ergometry by 15 minutes (once a day), associated with routine physiotherapy intervention (twice a day). The control group (CG) had routine physiotherapy intervention. The two-factor mixed ANOVA with Bonferroni correction tested the mobility status and muscle strength, evaluated by Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Results: Thirty-seven patients were eligible, but 24 completed the study (12 each group). There was an interaction between interventions (before and after) and groups for mobility (F=59.513, p=0.006). But there was no interaction for muscle strength (F=4.097 p=0.055). The groups were similar before intervention for mobility [(p=0.343); confidence interval: (CG: 8.239 to 10.761) and (EG: 7.405 to 9.928)], but only the experimental group demonstrated improvement in mobility post-intervention [(p=0.017); confidence interval: (15.807 to 21.193)]. Conclusion: Compared to routine physiotherapy, in-bed cycling improved the mobility level, but not in muscle strength. Perme score was sensible to measure the mobility evolution in critical patients.

Critical Care Cycling to Improve Lower Extremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients

IntroductionIn-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot...

Predictors of acute muscle loss in the intensive care unit: A secondary analysis of an in-bed cycling trial for critically ill patients

PurposeThe purpose of this study was to assist clinicians to identify critically ill patients at greatest risk of acute muscle loss and to analyse the associations between protein intake and exercise on acute muscle loss. Materials and methodsSecondary analysis of a single-centre randomised clinical trial of in-bed cycling using a mixed effects model was undertaken to examine the association between key variables and rectus femoris cross-sectional area (RFCSA). Groups were combined, and key variables for the cohort were modified Nutrition Risk in the Critically Ill (mNUTRIC) scores within the first days following intensive care unit admission, longitudinal RFCSA measurements, percent of daily recommended protein intake, and group allocation (usual care, in-bed cycling). RFCSA ultrasound measurements were taken at baseline and days 3, 7, and 10 to quantify acute muscle loss. All patients received usual care nutritional intake while in the intensive care unit. Patients allocated to the cycling group commenced in-bed cycling once safety criteria were met. ResultsAnalysis included all 72 participants, of which 69% were male, with a mean (standard deviation) age of 56 (17) years. Patients received a mean (standard deviation) of 59% (26%) of the minimum protein dose recommended for critically ill patients. Mixed-effects model results indicated that patients with higher mNUTRIC scores experienced greater RFCSA loss (estimate = −0.41; 95% confidence interval [CI] = −0.59 to −0.23). RFCSA did not share a statistically significant association with cycling group allocation (estimate = −0.59, 95% CI = −1.53 to 0.34), the percentage of protein requirements received (estimate = −0.48; 95% CI = −1.16 to 0.19), or a combination of cycling group allocation and higher protein intake (estimate = 0.33, 95% CI = −0.76 to 1.43). Conclusions and relevanceWe found that a higher mNUTRIC score was associated with greater muscle loss, but we did not observe a relationship between combined protein delivery and in-bed cycling and muscle loss. The low protein doses achieved may have impacted the potential for exercise or nutrition strategies to reduce acute muscle loss. Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN 12616000948493)

Early physiotherapy and chest wall oscillation in patients with COVID-19 disease at the intensive care unit: a pilot clinical trial

Over the past few years, the early mobilization and rehabilitation of patients in the intensive care unit (ICU) has drawn a lot of interest from the clinical and scientific communities. An interdisciplinary team treating patients suffering from serious conditions should include physiotherapy. Additionally, physiotherapy is utilized to treat and prevent the side effects of extended immobility or sleep, as well as to improve respiratory function. The purpose is to improve residual functionality; to avoid new and repeated hospitalizations; to improve health and quality of life. Exercises for the entire body (including early in-bed cycling), specialized breathing exercises, chest mobilization, relief help, drainage postures, vibration, verticalization, and passive movements are all crucial components of COVID-19 physiotherapy. Our goal was to evaluate the changes of functional condition of patients with COVID-19 in the acute stage using different physiotherapy methods: complex measures against mono therapy. In the research, 28 subjects (15 men and 13 women) were involved. A total of 84 physiotherapy procedures were performed. In the first group, breathing exercises and chest wall oscillation were applied, in the second group – only chest wall oscillation. Respiratory physiotherapy (breathing exercises) plays an important role in reducing and preventing respiratory complications in COVID-19 patients treated at ICU. Early mobilization and chest wall oscillation are beneficial in COVID-19 patients. We note that we are the first to conduct an evidence-based study of physiotherapy in intensive care with COVID-19 patients. We hope that our pilot clinical trial gives opportunity to future researches.

Preoperative Nutritional Optimization and Physical Exercise for Patients Scheduled for Elective Implantation for a Left-Ventricular Assist Device—The PROPER-LVAD Study

Background: Prehabilitation is gaining increasing interest and shows promising effects on short- and long-term outcomes among patients undergoing major surgery. The effect of multimodal, interdisciplinary prehabilitation has not yet been studied in patients with severe heart failure scheduled for the implantation of a left-ventricular assist device (LVAD). Methods: This randomized controlled multi-center study evaluates the effect of preoperative combined optimization of nutritional and functional status. Patients in the intervention group are prescribed daily in-bed cycling and oral nutrition supplements (ONS) from study inclusion until the day before LVAD-implantation. Patients in the control group receive standard of care treatment. The primary outcomes for the pilot study that involves 48 patients are safety (occurrence of adverse events), efficacy (group separation regarding the intake of macronutrients), feasibility of the trial protocol (compliance (percentage of received interventions) and confirmation of recruitment rates. Secondary outcomes include longitudinal measurements of muscle mass, muscle strength, physical function and quality of life, next to traditional clinical outcomes (30-day mortality, hospital and ICU length of stay, duration of mechanical ventilation and number of complications and infections). If the pilot study is successful, a larger confirmatory, international multicenter study is warranted.

The effect of the addition of in-bed leg cycling using a MOTOmed device to standard rehabilitation on the length of mechanical ventilation: a randomized clinical trial

Successful weaning from mechanical ventilation (MV) belongs to the challenges in critical care. The study evaluated the effect of the addition of in-bed leg cycling using a MOTOmed device to standard rehabilitation on the length of MV. Randomized open-label clinical trial. Sixty-seven mechanically ventilated patients were random allocated in the in-bed leg cycling MOTOmed group (m-group) and the control group (c-group). The standard physiotherapy was carried out twice a day in both groups. The m-group received additional in-bed leg cycling rehabilitation using a MOTOmed device once daily. We included 20 patients in m-group and 19 in c-group in the final analysis. In the m-group, a non-significant reduction in both total length of MV (21.0 ± 9.78 vs. 24.4 ± 10.88 days, p = 0.915) and length of MV from randomization (5.4 ± 6.17 vs. 8.7 ± 8.00 days, p = 0.860) was observed. Both groups had significant muscle strength improvement (knee joint extension, handgrip). However, the m-group patients reached the same muscle strength level in a shorter time (8.70 ± 6.44 vs. 6.8 ± 4.3 days, p = 0.534). In our study, adding the MOTOmed device in-bed leg cycling to standard rehabilitation did not significantly reduce mechanical ventilation length in critically ill patients.

Usual care protein intake does not affect acute sarcopenia. Secondary analysis of an in-bed cycling trial with critical ill patients

Introduction: Critically ill patients typically experience profound acute skeletal muscle loss. The associations between exercise interventions and protein intake to preserve skeletal muscle are unknown.

The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level.MethodsThis study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity.DiscussionIf a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP.Trial registrationClinicalTrials.gov NCT04094636. Registered on 1 April 2019

Functional electrical stimulation in-bed cycle ergometry in mechanically ventilated patients: a multicentre randomised controlled trial

PurposeTo investigate the effect of functional electrical stimulation-assisted cycle ergometry (FES-cycling) on muscle strength, cognitive impairment and related outcomes.MethodsMechanically ventilated patients aged ≥18 years with sepsis or systemic inflammatory response...

The experiences of cardiac surgery critical care clinicians with in-bed cycling in adult patients undergoing complex cardiac surgery

Purpose In-bed cycling is a novel modality that permits the early initiation of rehabilitation in the intensive care unit. We explored clinicians’ experiences and perceptions of in-bed cycling with critically ill cardiac surgery patients. Materials and methods We used an interpretive description methodology. All critical care clinicians who had been present for at least 2 cycling sessions were eligible. Data were collected using semi-structured, audio-recorded, face-to-face interviews transcribed verbatim. Content analysis was used to identify themes. Results Nine clinicians were interviewed. Our sample was predominantly female (77.8%) with a median [IQR] age of 40 [21.5] years. Critical care experience ranged from <5 years to ≥30 years. Acceptability was influenced by previous cycling experiences, identifying the “ideal” patient, and the timing of cycling within a patient’s recovery. Facilitators included striving towards a common goal and feeling confident in the method. Barriers included inadequate staffing, bike size, and the time to deliver cycling. Conclusions Clinicians supported the use of in-bed cycling. Concerns included appropriate patient selection and timing of the intervention. Teamwork was integral to successful cycling. Strategies to overcome the identified barriers may assist with successful cycling implementation in other critical care environments. IMPLICATIONS FOR REHABILITATION In-bed cycling is a relatively novel rehabilitation modality that can help initiate physical rehabilitation earlier in a patient’s recovery and reduce the iatrogenic effects of prolonged admissions to an intensive care unit. Clinicians found in-bed cycling to be an acceptable intervention with a population of critically ill cardiac surgery patients. Teamwork and interprofessional communication are important considerations for successful uptake of a relatively new rehabilitation modality. Identified barriers to in-bed cycling can assist with developing strategies to encourage cycling uptake in similar critical care environments.

Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage.

PurposeEvidence suggests that early physical activity can be accomplished safely in the neurocritical care unit (NCCU); however, many NCCU patients are often maintained in a state of inactivity due to impaired consciousness, sensorimotor deficits, and concerns for intracranial pressure elevation or cerebral hypoperfusion in the setting of autoregulatory failure. Structured in-bed mobility interventions have been proposed to prevent sequelae of complete immobility in such patients, yet the feasibility and safety of these interventions is unknown. We studied neurological and hemodynamic changes before and after cycle ergometry (CE) in a subset of NCCU patients with external ventricular drains (EVDs).MethodsPatients admitted to the NCCU who had an EVD placed for cerebrospinal fluid drainage and intracranial pressure (ICP) monitoring underwent supine CE therapy with passive and active cycling settings. Neurologic status, ICP and hemodynamic parameters were monitored before and after each CE session.ResultsTwenty-seven patients successfully underwent in-bed CE in the NCCU. No clinically significant changes were recorded in neurologic or in physiological parameters before or after CE. There were no device dislodgements or other adverse effects requiring cessation of a CE session.ConclusionThese data suggest that supine CE in a heterogeneous cohort of neurocritical care patients with EVDs is safe and tolerable. Larger prospective studies are needed to determine the efficacy and optimal dose and timing of supine CE in neurocritical care patients.

Hemodynamic responses to In-Bed Cycle Exercise in the acute phase after moderate to severe stroke: A randomized controlled trial.

Hemodynamic responses to exercise in the acute phase after moderate to severe stroke have remained poorly investigated. The aim of this randomized controlled study, in which 52 (32 women) patients with moderate to severe stroke were randomized to three weeks of 20 minutes in‐bed cycle exercise 5 days per week or to usual care, was to explore the systolic blood pressure (SBP) response to exercise and to evaluate the impact of the intervention on the resting and post‐test systolic and diastolic blood pressures and heart rate, and on the systolic blood pressure response to exercise. We found that resting SBP decreased from baseline to post‐intervention in both the intervention group (147.7 ± 18.1 mmHg to 125.3 ± 17.1 mmHg, P < .001) and in the control group (147.8 ± 23.7 mmHg to 131.4 ± 14.8 mmHg, P < .001) without a significant difference between the groups (interaction P = .308). However, there was a significant difference (interaction P = .010) regarding how Δ SBP (change in SBP from pre‐test to post‐test) changed from baseline to post‐intervention. In the intervention group, Δ SBP increased from −1.0 ± 15.0 mmHg to 8.5 ± 9.4 mmHg, P = .009, whereas in the control group, Δ SBP decreased from 7.1 + 10.9 mmHg to 4.5 + 11.8 mmHg, P = .395. We conclude that patients randomized to in‐bed cycle exercise seemed to normalize their blood pressure response to exercise to a larger extent than patients in the control group.

CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery

BackgroundIn-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients.MethodsWe conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events.ResultsWe screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4).ConclusionsIn-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample.Trial registrationThis trial was registered with Clinicaltrials.gov (NCT02976415). Registered November 29, 2016.