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Safety and Feasibility of a Protocolized Approach to In-Bed Cycling Exercise in the Intensive Care Unit: Quality
Ibtehal Kimawi1, Bryanna Lamberjack2, Archana Nelliot3
1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine.
Background:
In-bed, supine cycle ergometry as a part of early rehabilitation in the intensive care unit (ICU) appears to be safe, feasible, and beneficial, but no standardized protocol exists. A standardized protocol may help guide use of cycle ergometry in the ICU.
Objective:
This study investigated whether a standardized protocol for in-bed cycling is safe and feasible, results in cycling for a longer duration, and achieves a higher resistance.
Design:
A quality improvement (QI) project was conducted.
Methods:
A 35-minute in-bed cycling protocol was implemented in a single medical intensive care unit (MICU) over a 7-month quality improvement (QI) period compared to pre-existing, prospectively collected data from an 18-month pre-QI period.
Results:
One hundred and six MICU patients received 260 cycling sessions in the QI period vs. 178 MICU patients receiving 498 sessions in the pre-QI period. The protocol was used in 249 (96%) of cycling sessions. The QI group cycled for longer median (IQR) duration (35 [25-35] vs. 25 [18-30] minutes, P < .001) and more frequently achieved a resistance level greater than gear 0 (47% vs. 17% of sessions, P < .001). There were 4 (1.5%) transient physiologic abnormalities during the QI period, and 1 (0.2%) during the pre-QI period ( P = .031).
Limitations:
Patient outcomes were not evaluated to understand if the protocol has clinical benefits.
Conclusions:
Use of a protocolized approach for in-bed cycling appears safe and feasible, results in cycling for longer duration, and achieved higher resistance.