Juultje Sommers1, Emily Klooster2, Siebrand B Zoethout2, Huub L A van den Oever3, Frans Nollet4, Robert Tepaske5, Janneke Horn5, Raoul H H Engelbert6, Marike van der Schaaf6. 1. Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, Movement Sciences Amsterdam, The Netherlands. Electronic address: j.sommers@amc.uva.nl. 2. Department of Rehabilitation, Deventer Hospital, Deventer, The Netherlands. 3. Department of Intensive Care Medicine, Deventer Hospital, Deventer, The Netherlands. 4. Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, Movement Sciences Amsterdam, The Netherlands. 5. Amsterdam UMC, University of Amsterdam, Department of Intensive Care Medicine, Amsterdam. 6. Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, Movement Sciences Amsterdam, The Netherlands; ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To evaluate the feasibility and safety of exercise testing and to describe the physiological response to exercise of patients in the Intensive Care Unit (ICU). DESIGN: A prospective observational multicenter study. SETTING: Two mixed medical-surgical ICUs. PARTICIPANTS: Patients (N=37; with no primary neurological disorders, 59% men; median age 50y; ICU length of stay 14.5d; Acute Physiology and Chronic Health Evaluation IV 73.0) who had been mechanically ventilated for more than 48 hours and were hemodynamically stable enough to perform physical exercise. INTERVENTIONS: A passive or active incremental exercise test, depending on muscle strength, on a bed-based cycle ergometer. MAIN OUTCOME MEASURES: Feasibility and safety were evaluated based on protocol adherence and adverse events. Physiological responses to exercise quantified as changes in respiratory frequency (RF), oxygen uptake (Vo2), carbon dioxide output (Vco2), respiratory exchange ratio (RER), and blood lactate. RESULTS: Thirty-seven patients of whom 18 were mechanically ventilated underwent the exercise test. The active incremental test was performed by 28, and the passive test by 9 participants. Thirty-three (89%) accomplished the test according to the protocol and 1 moderate severe adverse event (bradycardia; heart rate 44) occurred shortly after the test. RF, Vo2, Vco2, and lactate increased significantly, whereas RER did not change during the active incremental exercise test. No changes were observed during the passive exercise test. CONCLUSIONS: It is safe and feasible to perform exercise testing on a bed-based cycle ergometer in patients who are critically ill and a physiological response could be measured. Future research should investigate the clinical value of exercise testing in daily ICU practice and whether exercise capacity and its limiting factors could be determined by incremental exercise testing.
OBJECTIVE: To evaluate the feasibility and safety of exercise testing and to describe the physiological response to exercise of patients in the Intensive Care Unit (ICU). DESIGN: A prospective observational multicenter study. SETTING: Two mixed medical-surgical ICUs. PARTICIPANTS: Patients (N=37; with no primary neurological disorders, 59% men; median age 50y; ICU length of stay 14.5d; Acute Physiology and Chronic Health Evaluation IV 73.0) who had been mechanically ventilated for more than 48 hours and were hemodynamically stable enough to perform physical exercise. INTERVENTIONS: A passive or active incremental exercise test, depending on muscle strength, on a bed-based cycle ergometer. MAIN OUTCOME MEASURES: Feasibility and safety were evaluated based on protocol adherence and adverse events. Physiological responses to exercise quantified as changes in respiratory frequency (RF), oxygen uptake (Vo2), carbon dioxide output (Vco2), respiratory exchange ratio (RER), and blood lactate. RESULTS: Thirty-seven patients of whom 18 were mechanically ventilated underwent the exercise test. The active incremental test was performed by 28, and the passive test by 9 participants. Thirty-three (89%) accomplished the test according to the protocol and 1 moderate severe adverse event (bradycardia; heart rate 44) occurred shortly after the test. RF, Vo2, Vco2, and lactate increased significantly, whereas RER did not change during the active incremental exercise test. No changes were observed during the passive exercise test. CONCLUSIONS: It is safe and feasible to perform exercise testing on a bed-based cycle ergometer in patients who are critically ill and a physiological response could be measured. Future research should investigate the clinical value of exercise testing in daily ICU practice and whether exercise capacity and its limiting factors could be determined by incremental exercise testing.
Authors: Madu N Soares; Moritz Eggelbusch; Elie Naddaf; Karin H L Gerrits; Marike van der Schaaf; Bram van den Borst; W Joost Wiersinga; Michele van Vugt; Peter J M Weijs; Andrew J Murray; Rob C I Wüst Journal: J Cachexia Sarcopenia Muscle Date: 2022-01-07 Impact factor: 12.910
Authors: Huub L A van den Oever; Mert Kök; Aloys Oosterwegel; Emily Klooster; Siebrand Zoethout; Erwin Ruessink; Bas Langeveld Journal: Physiol Rep Date: 2022-03