Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit

Michelle E Kho; Robert A Martin; Amy L Toonstra; Jennifer M Zanni; Earl C Mantheiy; Archana Nelliot; Dale M Needham

doi:10.1016/j.jcrc.2015.07.025

Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit

J Crit Care. 2015 Dec;30(6):1419.e1-5. doi: 10.1016/j.jcrc.2015.07.025. Epub 2015 Jul 29.

Authors

Michelle E Kho¹, Robert A Martin², Amy L Toonstra³, Jennifer M Zanni⁴, Earl C Mantheiy⁵, Archana Nelliot⁵, Dale M Needham⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; School of Rehabilitation Science, McMaster University, Hamilton, ON, L8S 1C7. Electronic address: khome@mcmaster.ca.
² University of Massachusetts Medical School, Worcester, MA, USA.
³ Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
⁴ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
⁵ Division of Pulmonary & Critical Care Medicine, Johns Hopkins University; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
⁶ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University; Outcomes After Critical Illness and Surgery, Johns Hopkins University.

PMID: 26318234
DOI: 10.1016/j.jcrc.2015.07.025

Abstract

Purpose: The purpose was to evaluate the feasibility and safety of in-bed cycle ergometry as part of routine intensive care unit (ICU) physical therapist (PT) practice.

Materials and methods: Between July 1, 2010, and December 31, 2011, we prospectively identified all patients admitted to a 16-bed medical ICU receiving cycling by a PT, prospectively collected data on 12 different potential safety events, and retrospectively conducted a chart review to obtain specific details of each cycling session.

Results: Six hundred eighty-eight patients received PT interventions, and 181 (26%) received a total of 541 cycling sessions (median [interquartile range {IQR}] cycling sessions per patient, 2 [1-4]). Patients' mean (SD) age was 57 (17) years, and 103 (57%) were male. The median (IQR) time from medical ICU admission to first PT intervention and first cycling session was 2 (1-4) and 4 (2-6) days, respectively, with a median (IQR) cycling session duration of 25 (18-30) minutes. On cycling days, the proportion of patients receiving mechanical ventilation, vasopressor infusions, and continuous renal replacement therapy was 80%, 8%, and 7%, respectively. A single safety event occurred, yielding a 0.2% event rate (95% upper confidence limit, 1.0%).

Conclusions: Use of in-bed cycling as part of routine PT interventions in ICU patients is feasible and appears safe. Further study of the potential benefits of early in-bed cycling is needed.

Keywords: Artificial; Critical illness; Cycle ergometry; Intensive care units; Muscle; Respiration.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Critical Care
Ergometry / methods*
Exercise Therapy*
Female
Humans
Intensive Care Units*
Male
Middle Aged
Patient Admission
Patient Safety*
Physical Therapy Modalities
Prospective Studies
Renal Replacement Therapy / methods*
Respiration, Artificial / methods*
Retrospective Studies

Grants and funding

Canadian Institutes of Health Research/Canada