TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients

Abstract

IntroductionThe objective of this study was to assess the safety and feasibility of in-bed cycling started within the first 4 days of mechanical ventilation (MV) to inform a future randomized clinical trial.MethodsWe conducted a 33-patient prospective cohort study in a 21-bed adult academic medical-surgical intensive care unit (ICU) in Hamilton, ON, Canada. We included adult patients (≥ 18 years) receiving MV who walked independently pre-ICU. Our intervention was 30 minutes of in-bed supine cycling 6 days/week in the ICU. Our primary outcome was Safety (termination), measured as events prompting cycling termination; secondary Safety (disconnection or dislodgement) outcomes included catheter/tube dislodgements. Feasibility was measured as consent rate and fidelity to intervention. For our primary outcome, we calculated the binary proportion and 95% confidence interval (CI).ResultsFrom 10/2013-8/2014, we obtained consent from 34 of 37 patients approached (91.9%), 33 of whom received in-bed cycling. Of those who cycled, 16(48.4%) were female, the mean (SD) age was 65.8(12.2) years, and APACHE II score was 24.3(6.7); 29(87.9%) had medical admitting diagnoses. Cycling termination was infrequent (2.0%, 95% CI: 0.8%-4.9%) and no device dislodgements occurred. Cycling began a median [IQR] of 3 [2, 4] days after ICU admission; patients received 5 [3, 8] cycling sessions with a median duration of 30.7 [21.6, 30.8] minutes per session. During 205 total cycling sessions, patients were receiving invasive MV (150 [73.1%]), vasopressors (6 [2.9%]), sedative or analgesic infusions (77 [37.6%]) and dialysis (4 [2.0%]).ConclusionsEarly cycling within the first 4 days of MV among hemodynamically stable patients is safe and feasible. Research to evaluate the effect of early cycling on patient function is warranted.Trial RegistrationClinicaltrials.gov: NCT01885442

CYCLE pilot: a protocol for a pilot randomised study of early cycle ergometry versus routine physiotherapy in mechanically ventilated patients

“… 64 66 Unlike ambulation during MV, which can require up to four clinicians, 67 cycling only requires the assistance of one clinician. 16 Our pilot data support the safety and feasibility of early cycling in critically ill patients receiving MV 68 and we are engaging front-line PTs to provide the cycling intervention as part of normal care, in anticipation of future knowledge translation efforts. To reduce detection bias, we will conduct blinded functional outcome assessments at hospital discharge.…”

Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial

“…This would favour the higher frequency of physiotherapy sessions (11%) in the intervention group, although this percentage might have been insufficient to reach clinical significance. Similarly, the stepwise approach of our study might have been too ambitious for the allocated therapy time (7min extra) and cycling insufficiently dosed (15min versus 30min reported by [ 47 , 48 ]) to induce musculoskeletal adaptations. However, the small but significant changes in hemodynamic or oxygen-transport variables appeared to have been sufficient to stimulate patients to meet the metabolic demands of exercise by adequate cardiorespiratory adaptations.…”

Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation

“…The following are the key points and strategies for the rehabilitation of ventilated patients with clear cognitive status: Activities: In-bed cycling in patients with critical illness has been shown to be a safe and feasible procedure for preserving muscle function 41 and muscle fiber cross-sectional area, 42 as well as fostering positive mental effect, including the feeling of control, safety, and hope, during the critical stages of the illness. 43 Low resistance levels (i.e., approximately 0.5 Nm), are recommended with patient self-selected pedaling rate for 30 min daily.…”