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