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Functional electrical stimulation in-bed cycle ergometry in mechanically ventilated patients: a multicentre
Sue Berney1,2, Ramona O Hopkins3,4,5, Joleen Wyn Rose2
1Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia sue.berney@austin.org.au.
Thorax
|December 16, 2020
Summary
Functional electrical stimulation-assisted cycle ergometry (FES-cycling) did not significantly improve muscle strength or reduce cognitive impairment in critically ill patients. This intensive care unit intervention showed no substantial benefits over usual care rehabilitation alone.
Area of Science:
- Critical Care Medicine
- Rehabilitation Science
- Neurology
Background:
- Mechanically ventilated patients with sepsis or systemic inflammatory response syndrome often experience muscle weakness and cognitive impairment.
- Intensive care unit (ICU) acquired weakness and cognitive dysfunction significantly impact patient recovery and long-term outcomes.
- Functional electrical stimulation-assisted cycle ergometry (FES-cycling) is a potential intervention to mitigate these deficits.
Purpose of the Study:
- To evaluate the efficacy of FES-cycling as an adjunct to usual care rehabilitation in improving muscle strength and reducing cognitive impairment in critically ill patients.
- To assess the impact of FES-cycling on secondary outcomes, including in-hospital and long-term functional recovery.
Main Methods:
- A randomized controlled trial involving 162 mechanically ventilated adult patients with sepsis or SIRS across four international sites.
- Participants were assigned to either 60 minutes of FES-cycling plus usual care rehabilitation or usual care rehabilitation alone, 5 days per week in the ICU.
- Primary outcomes included muscle strength at hospital discharge and cognitive impairment at 6-month follow-up.
Main Results:
- No significant difference in muscle strength at hospital discharge between the FES-cycling group (n=80) and the control group (n=82).
- The prevalence of cognitive impairment at 6 months was similar between groups (OR 1.1; 95% CI 0.30 to 3.8).
- No significant differences were observed for secondary outcomes measured during hospitalization and at 6 and 12 months follow-up.
Conclusions:
- The addition of FES-cycling to usual care rehabilitation did not substantially improve muscle strength at hospital discharge in this patient population.
- While the incidence of cognitive impairment was nearly identical between groups at 6 months, the study's imprecision prevents definitive conclusions on cognitive effects.
- Further research may be needed to explore potential benefits or harms of FES-cycling on cognition in critically ill patients.
