title: Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects--a case series.
abstract: BACKGROUND
  Early mobilization can be performed in critically ill patients and improves outcomes. A daily cycling exercise started from day 5 after ICU admission is feasible and can enhance functional capacity after hospital discharge. In the present study we verified the physiological changes and safety of an earlier cycling intervention (< 72 hrs of mechanical ventilation) in critical ill patients.
  
  
  METHODS
  Nineteen hemodynamically stable and deeply sedated patients within the first 72 hrs of mechanical ventilation were enrolled in a single 20 minute passive leg cycling exercise using an electric cycle ergometer. A minute-by-minute evaluation of hemodynamic, respiratory and metabolic variables was undertaken before, during and after the exercise. Analyzed variables included the following: cardiac output, systemic vascular resistance, central venous blood oxygen saturation, respiratory rate and tidal volume, oxygen consumption, carbon dioxide production and blood lactate levels.
  
  
  RESULTS
  We enrolled 19 patients (42% male, age 55 ± 17 years, SOFA = 6 ± 3, SAPS3 score = 58 ± 13, PaO2/FIO2 = 223 ± 75). The median time of mechanical ventilation was 1 day (02), and 68% (n=13) of our patients required norepinephrine (maximum concentration = 0.47 µg.kg(-1).min(-1)). There were no clinically relevant changes in any of the analyzed variables during the exercise, and two minor adverse events unrelated to hemodynamic instability were observed.
  
  
  CONCLUSIONS
  In our study, this very early passive cycling exercise in sedated, critically ill, mechanically ventilated patients was considered safe and was not associated with significant alterations in hemodynamic, respiratory or metabolic variables even in those requiring vasoactive agents.
authors.affiliation: Physical Therapy Service, Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo (ICHC-FMUSP), São Paulo, Brazil ; Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, São Paulo, Brazil.
authors.forename: Ruy
authors.initials: R
authors.lastname: Camargo Pires-Neto
authors.forename: Yurika Maria
authors.initials: YM
authors.lastname: Fogaça Kawaguchi
authors.forename: Adriana
authors.initials: A
authors.lastname: Sayuri Hirota
authors.forename: Carolina
authors.initials: C
authors.lastname: Fu
authors.forename: Clarice
authors.initials: C
authors.lastname: Tanaka
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Carlos Roberto
authors.initials: CR
authors.lastname: Ribeiro Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002302:Cardiac Output; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D009638:Norepinephrine / Q000627:therapeutic use; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology; D061214:Patient Safety; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial; D013566:Sympathomimetics / Q000627:therapeutic use; D013990:Tidal Volume / Q000502:physiology; D013997:Time Factors
chemical_list: D013566:Sympathomimetics; D009638:Norepinephrine
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