Keeping patients moving in the ICU

Down time is great for catching a movie while lying on the couch, but it can lead to muscle weakness and atrophy for patients in the ICU. A study, published in PLOS ONE, tests the safety and feasibility of in-bed cycling for patients on mechanical ventilation.

"People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge," said the study's lead author Michelle Kho, an assistant professor at McMaster University and physiotherapist at St. Joseph's Healthcare Hamilton in Ontario, Canada. "Our TryCYCLE study builds on this previous work and finds it is safe and feasible to systematically start in-bed cycling within the first four days of mechanical ventilation and continue throughout a patient's ICU stay."

Targeting legs and hips, cycling is a viable option to keep patients safe in the ICU with mechanical ventilation. The movements keep muscles strong and may be able to help them heal more quickly while limiting costs for patients and facilities. This study, conducted at St. Joseph's Healthcare Hamilton, was able to test the safety and feasibility of a cycling intervention in patients over 18, who had received mechanical ventilation and had been walking independently before admission to the ICU.

Over the course of a year, 33 patients received 30 minutes of in-bed supine cycling for six days a week. Results showed that early cycling intervention within the first four days of ICU admission for patients with mechanical ventilation was a safe and feasible practice.

“Our results suggest that it is safe and feasible to enroll critically ill, hemodynamically stable MV patients in a rehabilitation study of early cycling,” wrote Kho. “We began cycling within three days of ICU admission, session termination was infrequent and device dislodgements did not occur. On average, patients received five cycling sessions [for] 30 minutes, cycled one kilometer per session and cycled a distance of nine kilometers in total in the ICU.”