Safe Early Cycling Exercises for Critical Care Patients – Critical Care

Image: Cycling exercise in the ECU improves patient outcomes (Photo courtesy of Michelle Kho / St. Joseph’s).

Early bicycle exercise by mechanically ventilated patients in the hospital’s intensive care unit (ICU) may help them recover faster, a new study finds.

Researchers from St. Joseph’s Healthcare (St. Joe’s; Hamilton, Canada), McMaster University (Hamilton, Canada), Johns Hopkins University (JHU, Baltimore, MD, USA) and other institutions conducted a prospective cohort study in 33 patients receiving mechanical ventilation therapy who worked independently prior to ICU internment. The intervention included 30 minutes of recumbent cycling six days a week in the intensive care unit. The primary outcome was cycle arrest, with a secondary safety outcome that included catheter or tube dislodgement.

Cycling began an average of three days after ICU admission, with patients receiving five 30-minute cycling sessions per session, covering an average of nine kilometers in total during their stay in intensive care. During the 205 total cycling sessions, 73% of patients received invasive mechanical ventilation, vasopressors were taken by 2.9% of study participants, sedative or analgesic infusions were taken by 37.6% of patients and 2% were on dialysis. Stopping of the cycle was infrequent and no dislodgement of the device occurred. The study was published on December 28, 2016 in PLOS One.

“People may think that intensive care patients are too sick to be physically active, but we know that if patients start biking in bed two weeks after their intensive care stay, they will walk further to discharge, “said senior author, physiotherapist Michelle Kho, PhD, of the School of Rehabilitation Sciences at McMaster University and St. Joe’s. “… it is safe and doable to start cycling in bed consistently during the first four days of mechanical ventilation and continue throughout a patient’s stay in intensive care.” “

Cycling in bed is a promising early intervention for critically ill patients that provides low-intensity movement that allows spontaneous participation in activity (with pauses) in severely deconditioned patients. Commercially available devices offer three possible activity modes: passive (fully motorized, no patient initiation), active-assisted (partially patient initiated), or active (fully patient initiated). The intervention helps prevent or reduce loss of muscle mass and minimize loss of strength, thereby helping to improve long-term outcomes in ICU survivors.

Related links:
Saint-Joseph health care
McMaster University
Johns Hopkins University

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