Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

doi:10.1056/EVIDoa2400137

Randomized Controlled Trial

. 2024 Jul;3(7):EVIDoa2400137.

doi: 10.1056/EVIDoa2400137. Epub 2024 Jun 12.

Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

Michelle E Kho^{1

2}, Susan Berney^{3

4}, Amy M Pastva⁵, Laurel Kelly², Julie C Reid¹, Karen E A Burns^{6

7}, Andrew J Seely^{8

9}, Frédérick D'Aragon^{10

11}, Bram Rochwerg^{12

13}, Ian Ball^{14

15}, Alison E Fox-Robichaud^{12

16}, Tim Karachi¹², Francois Lamontagne^{11

17}, Patrick M Archambault^{18

19}, Jennifer L Tsang^{12

20}, Erick H Duan¹², John Muscedere^{21

22}, Avelino C Verceles²³, Karim Serri²⁴, Shane W English^{25

26}, Brenda K Reeve²⁷, Sangeeta Mehta^{28

29}, Jill C Rudkowski¹², Diane Heels-Ansdell¹³, Heather K O'Grady¹, Geoff Strong¹, Kristy Obrovac², Daana Ajami², Laura Camposilvan², Jean-Eric Tarride^{13

30}, Lehana Thabane^{13

31}, Margaret S Herridge³², Deborah J Cook^{12

13}

Affiliations

¹ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
² Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³ Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia.
⁴ Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC.
⁶ Interdepartmental Division of Critical Care, University of Toronto, Toronto.
⁷ Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto.
⁸ Department of Surgery, University of Ottawa, Ottawa.
⁹ Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa.
¹⁰ Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
¹¹ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹² Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹³ Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Medicine, Western University, London, ON, Canada.
¹⁵ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
¹⁶ Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁷ Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
¹⁸ Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
¹⁹ Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
²⁰ Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada.
²¹ Queen's University, Kingston, ON, Canada.
²² Department of Critical Care Medicine, Kingston, ON, Canada.
²³ Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore.
²⁴ Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal.
²⁵ Department of Medicine (Critical Care), University of Ottawa, Ottawa.
²⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa.
²⁷ Department of Medicine, Brantford General Hospital, Brantford, ON, Canada.
²⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto.
²⁹ Department of Medicine, Sinai Health System, Toronto.
³⁰ Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
³¹ Research Institute of St. Joe's, Hamilton, ON, Canada.
³² Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto.

PMID: 38865147
DOI: 10.1056/EVIDoa2400137

Randomized Controlled Trial

Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

Michelle E Kho et al. NEJM Evid. 2024 Jul.

. 2024 Jul;3(7):EVIDoa2400137.

doi: 10.1056/EVIDoa2400137. Epub 2024 Jun 12.

Authors

Affiliations

¹ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
² Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³ Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia.
⁴ Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC.
⁶ Interdepartmental Division of Critical Care, University of Toronto, Toronto.
⁷ Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto.
⁸ Department of Surgery, University of Ottawa, Ottawa.
⁹ Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa.
¹⁰ Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
¹¹ Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
¹² Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹³ Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Medicine, Western University, London, ON, Canada.
¹⁵ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
¹⁶ Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁷ Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
¹⁸ Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
¹⁹ Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
²⁰ Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada.
²¹ Queen's University, Kingston, ON, Canada.
²² Department of Critical Care Medicine, Kingston, ON, Canada.
²³ Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore.
²⁴ Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal.
²⁵ Department of Medicine (Critical Care), University of Ottawa, Ottawa.
²⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa.
²⁷ Department of Medicine, Brantford General Hospital, Brantford, ON, Canada.
²⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto.
²⁹ Department of Medicine, Sinai Health System, Toronto.
³⁰ Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
³¹ Research Institute of St. Joe's, Hamilton, ON, Canada.
³² Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto.

PMID: 38865147
DOI: 10.1056/EVIDoa2400137

Abstract

Background: Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment.

Methods: We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function).

Results: Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29).

Conclusions: Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).

PubMed Disclaimer

Comment in

Cycling in ICU - Keep Peddling or Push the Brakes?
Hodgson CL, Paton M. Hodgson CL, et al. NEJM Evid. 2024 Jul;3(7):EVIDe2400176. doi: 10.1056/EVIDe2400176. Epub 2024 Jun 25. NEJM Evid. 2024. PMID: 38916423 No abstract available.

Cited by

Accelerometer-derived movement features as predictive biomarkers for muscle atrophy in neurocritical care: a prospective cohort study.
Schmidbauer ML, Putz T, Gehri L, Ratkovic L, Maskos A, Zibold J, Bauchmüller J, Imhof S, Weig T, Wuehr M, Dimitriadis K. Schmidbauer ML, et al. Crit Care. 2024 Aug 31;28(1):288. doi: 10.1186/s13054-024-05067-y. Crit Care. 2024. PMID: 39217360 Free PMC article.
Barriers, Solutions, and Opportunities for Adapting Critical Care Clinical Trials in the COVID-19 Pandemic.
Cook D, Taneja S, Krewulak K, Zytaruk N, Menon K, Fowler R, Lamontagne F, Kho ME, Rochwerg B, Masse MH, Lauzier F, O'Hearn K, Adhikari NKJ, Burns KEA, Bosma KJ, English S, McNally D, Turgeon AF, Brochard L, Parker M, Clayton L, Rishu A, Tuttle A, Daneman N, Fergusson D, McIntyre L, Kelly L, Orr S, Austin P, Mulligan S, Fiest K; Canadian Critical Care Trials Group and Canadian Clinical Research Network. Cook D, et al. JAMA Netw Open. 2024 Jul 1;7(7):e2420458. doi: 10.1001/jamanetworkopen.2024.20458. JAMA Netw Open. 2024. PMID: 38995645 Free PMC article.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov
Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
- Atypon
- Ovid Technologies, Inc.

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

Affiliations

Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

Authors

Affiliations

Abstract

Comment in

Similar articles

Cited by

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Abstract

Comment in

Similar articles

Cited by

Publication types

MeSH terms

Associated data

Related information

LinkOut - more resources

Full Text Sources