Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial

Nickels, Marc; Aitken, Leanne M.; Barnett, Adrian; Walsham, James; King, Scott; Gale, Nicolette E.; Bowen, Alicia; Peel, Brent M.; Donaldson, Samuel L.; Mealing, Stewart T.J.; McPhail, Steven

doi:10.1016/j.jcrc.2020.05.008

Cited by 27 publications

(39 citation statements)

References 52 publications

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“…Enhanced training of upper limbs may improve mortality and physical impairment related to muscle atrophy. In critically ill patients, lower limb training is predominantly the rehabilitation focus based on the concern for early mobilization [ 35 , 36 ]. However, in recent studies, neuromuscular electrical stimulation has been additionally used for upper limb training [ 37 – 39 ], preventing upper limb muscle atrophy, and the enhanced upper limb training reduced the length of hospitalization [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

et al. 2020

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Background Lower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function. Methods In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU). Results Sixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge. Conclusions Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) Trial registration UMIN 000031316. Retrospectively registered on 15 February 2018.

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Section: Discussionmentioning

confidence: 99%

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

et al. 2020

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“…Nickels et al [20] conducted a RCT in 72 critically ill patients with 30 min of daily in-bed cycling in addition to usual-care physiotherapy ( n = 37) versus usual-care physiotherapy ( n = 37). Ultrasound rectus femoris CSA was blindly assessed at day 10 after enrolment.…”

Section: Countermeasures Against Muscle Lossmentioning

confidence: 99%

Monitoring muscle mass using ultrasound: a key role in critical care

Ruijven

Stapel²,

Molinger

et al. 2021

Current Opinion in Critical Care

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Purpose of reviewThe loss of muscle mass in critically ill patients contributes to morbidity and mortality, and results in impaired recovery of physical functioning. The number of publications on the topic is increasing. However, there is a lack of consistent methodology and the most optimal methodology remains unclear, hampering its broad use in clinical practice. Recent findingsThere is a large variety of studies recently published on the use of ultrasound for assessment of muscle mass. A selection of studies has been made, focusing on monitoring of muscle mass (repeated measurements), practical aspects, feasibility and possible nutrition and physical therapy interventions. In this review, 14 new small (n ¼ 19--121) studies are categorized and reviewed as individual studies.

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“…Since then, several studies have shown that early physical activity can improve outcomes if applied in the very early within three days of mechanical ventilation [14,15]. Concerning the in-bed leg cycling, a non-beneficial data related to the outcomes (non-significant influence on muscle wasting, cardiovascular performance and respiratory mechanics) in critically ill patients was recently published [16,17].…”

Section: Introductionmentioning

confidence: 99%

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

2022

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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.

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Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial

Cited by 27 publications

References 52 publications

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

Monitoring muscle mass using ultrasound: a key role in critical care

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

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