Early Exercise in Critically Ill Youth and Children, a Preliminary Evaluation: The wEECYCLE Pilot Trial
Karen Choong1, Saif Awladthani, Adeeb Khawaji
11Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada. 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 3Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada. 4Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. 5King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
Insights
Early mobilization using in-bed cycling is safe and feasible for critically ill children in the pediatric intensive care unit (PICU). This pilot study suggests it may increase mobilization duration and intensity, warranting a full trial.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Therapy
- Clinical Trial Feasibility
Background:
- Critically ill children in the pediatric intensive care unit (PICU) often experience prolonged immobility, leading to potential functional deficits.
- Early mobilization is crucial for improving outcomes in adult ICU patients, but its feasibility in pediatric populations requires further investigation.
- In-bed cycling presents a potential method for early, safe mobilization in the PICU setting.
Purpose of the Study:
- To assess the feasibility and safety of early mobilization using in-bed cycling as an adjunct to physiotherapy in critically ill children.
- To determine if in-bed cycling can increase the duration and intensity of mobilization compared to usual care.
- To inform the design of a larger, full-scale randomized controlled trial (RCT) evaluating the efficacy of this intervention.
Main Methods:
- A single-center, pilot randomized controlled trial was conducted in a 12-bed tertiary medical-surgical PICU.
- Children aged 3-17 years with an expected PICU stay of at least 48 hours were randomized (2:1) to either early mobilization with in-bed cycling plus usual physiotherapy or usual physiotherapy alone.
- Feasibility and safety were the primary outcomes, with secondary assessments including time to mobilization and duration of therapy.
Main Results:
- Thirty patients were enrolled with a high consent rate (93.7%).
- The in-bed cycling group showed a shorter time to mobilization (1.5 days vs. 2.5 days) and greater total duration of mobilization therapy (210 min vs. 136 min).
- No adverse events were reported in either group; however, physiotherapist availability was identified as a key challenge to feasibility.
Conclusions:
- Early mobilization, including in-bed cycling, is a safe and feasible intervention for critically ill children in the PICU.
- In-bed cycling appears to facilitate increased duration and intensity of mobilization in this population.
- A full-scale RCT is recommended to definitively evaluate the efficacy of early mobilization with in-bed cycling on functional outcomes and PICU-acquired morbidities.
Objectives:
To determine the feasibility of conducting a full trial evaluating the efficacy of early mobilization using in-bed cycling as an adjunct to physiotherapy, on functional outcomes in critically ill children.
Design:
Single center, pilot, randomized controlled trial.
Setting:
Twelve-bed tertiary care, medical-surgical PICU at McMaster Children's Hospital, Hamilton, ON, Canada.
Patients:
Children 3-17 years old who were limited to bed-rest with an expected PICU stay of at least 48 hours. Patients were excluded if they were at their baseline level of function, already mobilizing out of bed or expected to do so within 24 hours.
Interventions:
Patients were randomized in a 2:1 ratio to early mobilization using in-bed cycling in addition to usual care physiotherapy (cycling arm) or to usual care physiotherapy alone (control). Usual care was according to institutional practice guidelines. The primary outcome was feasibility and safety.
Measurements And Main Results:
Thirty patients were enrolled (20 to the cycling and 10 to control) over a 12-month period, at a 93.7% consent rate. The median (interquartile range) time from PICU admission to mobilization was 1.5 days (1-3) in the cycling arm and 2.5 days (2-7) in the control arm. Total duration of mobilization therapy in PICU was 210 (152-380) and 136 minutes (42-314 min) in cycling and control arms, respectively. Total number of PICU days mobilized was 5.0 (3-6) with cycling and 2.5 (2-4.8) with usual care. No adverse events occurred in either arm. The main threat to feasibility of mobilization was the availability of physiotherapists or research personnel.
Conclusions:
Early mobilization is safe and feasible in the PICU. In-bed cycling may facilitate greater duration and intensity of mobilization, in critically ill children. A full-scale randomized controlled trial is warranted to evaluate the efficacy of this intervention on PICU-acquired morbidities and functional outcomes in this population.
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