Early Exercise in Critically Ill Youth and Children, a Preliminary Evaluation: The wEECYCLE Pilot Trial*

Abstract

Early mobilization is safe and feasible in the PICU. In-bed cycling may facilitate greater duration and intensity of mobilization, in critically ill children. A full-scale randomized controlled trial is warranted to evaluate the efficacy of this intervention on PICU-acquired morbidities and functional outcomes in this population.

Early Mobilization in Critically Ill Children: A Systematic Review

“…35 The results of this review suggest that levels of comfort with mobilization may be evolving with increasing safety and feasibility data in children and indirect evidence from the adult population. Cardiorespiratory instability 20,21 Mortality (no. of deaths recorded) 1220 (9 observational studies) ⊕○○○ Very low †, ‡, § Across 9 studies, 4 deaths were reported among 494 children receiving mobilization (0.8%) vs 27 of 720 (3.75%) in control group.…”

“…[22][23][24][25][26][27][28][29][30] Length of stay in PICU (days recorded) 30 (1 RCT) ⊕⊕○○ Low* Authors reported an overall length of PICU stay of 8.0 days (IQR, 5.0-13.8) with no distinction among groups. 20 Length of stay in PICU (days recorded) 1171 (7 observational studies) ⊕○○○ Very low †, ‡, § Two studies (n = 257 patients) did not detect a significant difference between groups. 25,26 Three studies 27,28,30 with 314 patients favor the mobility group; while one multicenter study 29 with 600 patients observed a difference favoring the group without mobilization.…”

“…26 The wEECYCLE pilot RCT evaluated early mobilization practice guidelines as their standard of care, which recommended screening for appropriateness within 24 hours of PICU admission, and defined early as when contraindications are absent and a set of systems-based safety criteria are met. 19,20…”

“…The 4 pre-post studies and the wEECYCLE Pilot RCT found that the institution of interdisciplinary early mobilization programs significantly increased the frequency of rehabilitation consults, improved the proportion of patients who receive early mobilization, and reduced the time to mobilization. 20,[25][26][27][28] The following efficacy outcomes have been evaluated as secondary endpoints: duration of mechanical ventilation, PICU duration of stay, mortality, and PICU-acquired morbidities. Only 1 study measured functional outcomes.…”

“…Only 1 study measured functional outcomes. 20 The effect of mobilization on these outcomes and the certainty of the evidence as assessed using GRADE are summarized in Table IV. The overall certainty of evidence for these outcomes was low or very low.…”