Anastasia N L Newman1,2, Michelle E Kho3,4, Jocelyn E Harris3, Nasim Zamir5, Ellen McDonald6, Alison Fox-Robichaud7,6, Patricia Solomon3. 1. School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. newmanan@mcmaster.ca. 2. Hamilton General Hospital, Hamilton, Ontario, Canada. newmanan@mcmaster.ca. 3. School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. 4. Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 5. College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 6. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada. 7. Hamilton General Hospital, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients. METHODS: We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events. RESULTS: We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4). CONCLUSIONS: In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov ( NCT02976415 ). Registered November 29, 2016.
BACKGROUND: In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients. METHODS: We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events. RESULTS: We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4). CONCLUSIONS: In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov ( NCT02976415 ). Registered November 29, 2016.
Entities:
Keywords:
Cardiac surgery; Critical care; Intensive care unit; Physiotherapy; Rehabilitation
Authors: Michelle E Kho; Robert A Martin; Amy L Toonstra; Jennifer M Zanni; Earl C Mantheiy; Archana Nelliot; Dale M Needham Journal: J Crit Care Date: 2015-07-29 Impact factor: 3.425
Authors: William D Schweickert; Mark C Pohlman; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn E McCallister; Jesse B Hall; John P Kress Journal: Lancet Date: 2009-05-14 Impact factor: 79.321
Authors: Chris Burtin; Beatrix Clerckx; Christophe Robbeets; Patrick Ferdinande; Daniel Langer; Thierry Troosters; Greet Hermans; Marc Decramer; Rik Gosselink Journal: Crit Care Med Date: 2009-09 Impact factor: 7.598
Authors: Michelle E Kho; Alexander J Molloy; France J Clarke; Daana Ajami; Magda McCaughan; Kristy Obrovac; Christina Murphy; Laura Camposilvan; Margaret S Herridge; Karen K Y Koo; Jill Rudkowski; Andrew J E Seely; Jennifer M Zanni; Marina Mourtzakis; Thomas Piraino; Deborah J Cook Journal: PLoS One Date: 2016-12-28 Impact factor: 3.240
Authors: Elie Azoulay; Jean-Louis Vincent; Derek C Angus; Yaseen M Arabi; Laurent Brochard; Stephen J Brett; Giuseppe Citerio; Deborah J Cook; Jared Randall Curtis; Claudia C Dos Santos; E Wesley Ely; Jesse Hall; Scott D Halpern; Nicholas Hart; Ramona O Hopkins; Theodore J Iwashyna; Samir Jaber; Nicola Latronico; Sangeeta Mehta; Dale M Needham; Judith Nelson; Kathleen Puntillo; Michael Quintel; Kathy Rowan; Gordon Rubenfeld; Greet Van den Berghe; Johannes Van der Hoeven; Hannah Wunsch; Margaret Herridge Journal: Crit Care Date: 2017-12-05 Impact factor: 9.097
Authors: Michelle E Kho; Alexander J Molloy; France J Clarke; Julie C Reid; Margaret S Herridge; Timothy Karachi; Bram Rochwerg; Alison E Fox-Robichaud; Andrew Je Seely; Sunita Mathur; Vincent Lo; Karen Ea Burns; Ian M Ball; Joseph R Pellizzari; Jean-Eric Tarride; Jill C Rudkowski; Karen Koo; Diane Heels-Ansdell; Deborah J Cook Journal: BMJ Open Respir Res Date: 2019-02-18