Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial

Abstract

BackgroundPatients in Intensive Care Units (ICU) are often exposed to prolonged immobilization which, in turn, plays an important role in neuromuscular complications. Exercise with a cycle ergometer is a treatment option that can be used to improve the rehabilitation of patients on mechanical ventilation (MV) in order to minimize the harmful effects of immobility.Methods/DesignA single-blind randomized controlled trial (the MoVe ICU study) will be conducted to evaluate and compare the effects of early rehabilitation using a bedside cycle ergometer with conventional physical therapy on the muscle morphology of the knee extensors and diaphragm in critical ill patients receiving MV. A total of 28 adult patients will be recruited for this study from among those admitted to the intensive care department at the Hospital de Clínicas de Porto Alegre. Eligible patients will be treated with MV from a period of 24 to 48 h, will have spent maximum of 1 week in hospital and will not exhibit any characteristics restricting lower extremity mobility. These subjects will be randomized to receive either conventional physiotherapy or conventional physiotherapy with an additional cycle ergometer intervention. The intervention will be administered passively for 20 min, at 20 revolutions per minute (rpm), once per day, 7 days a week, throughout the time the patients remain on MV. Outcomes will be cross-sectional quadriceps thickness, length of fascicle, pennation angle of fascicles, thickness of vastus lateralis muscle, diaphragm thickness and excursion of critical ICU patients on MV measured with ultrasound.DiscussionThe MoVe-ICU study will be the first randomized controlled trial to test the hypothesis that early rehabilitation with a passive cycle ergometer can preserve the morphology of knee extensors and diaphragm in critical patients on MV in ICUs.Trial registrationNCT02300662 (25 November 2014).

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

“…The feasibility and safety of BEDCYC was established in previous studies [37] and is a promising physical rehabilitation intervention for patients on ICU. The efficacy and effectiveness relative to standard treatment alone for BEDCYC will be investigated in other RCTs [37, 50]. The MOBILITY intervention is not yet described in the literature, but MOBILITY was tested over several months at our department and seems a feasible physical rehabilitation intervention for patients on ICU.…”

Overview of Intensive Care Unit‐Related Physical and Functional Impairments and Rehabilitation‐Related Devices

“…Skeletal muscle mass deteriorates at a rate of 5% per week in the ICU setting. 5 Critical illness myopathy has been reported in 58%-96% of ICU patients, 6 and cross-sectional muscle area may be lost up to 4 weeks after ICU discharge. 11 Physical and occupational therapy (OT) in ICU patients may reduce atrophy and improve muscle function, and has been demonstrated to be feasible and safe.…”

“…Particularly, immobilization is a major risk factor for acquired myopathy and neuropathy, referred to as critical illness myopathy and critical illness polyneuropathy, respectively . Studies suggest 58%–96% of patients surviving critical illness experience these conditions . Rehabilitation after critical illness is a multidisciplinary effort, and physical rehabilitation is a component.…”

“…Skeletal muscle mass deteriorates at a rate of 5% per week in the ICU setting . Critical illness myopathy has been reported in 58%–96% of ICU patients, and cross‐sectional muscle area may be lost up to 4 weeks after ICU discharge …”

“…1,4 Studies suggest 58%-96% of patients surviving critical illness experience these conditions. 1,4,6 Rehabilitation after critical illness is a multidisciplinary effort, and physical rehabilitation is a component. Other components include medical stabilization and optimizing nutrition support.…”