title: Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit.
abstract: OBJECTIVE
  The purpose was to evaluate the feasibility and safety of in-bed cycle ergometry as part of routine intensive care unit (ICU) physical therapist (PT) practice.
  
  
  METHODS
  Between July 1, 2010, and December 31, 2011, we prospectively identified all patients admitted to a 16-bed medical ICU receiving cycling by a PT, prospectively collected data on 12 different potential safety events, and retrospectively conducted a chart review to obtain specific details of each cycling session.
  
  
  RESULTS
  Six hundred eighty-eight patients received PT interventions, and 181 (26%) received a total of 541 cycling sessions (median [interquartile range {IQR}] cycling sessions per patient, 2 [1-4]). Patients' mean (SD) age was 57 (17) years, and 103 (57%) were male. The median (IQR) time from medical ICU admission to first PT intervention and first cycling session was 2 (1-4) and 4 (2-6) days, respectively, with a median (IQR) cycling session duration of 25 (18-30) minutes. On cycling days, the proportion of patients receiving mechanical ventilation, vasopressor infusions, and continuous renal replacement therapy was 80%, 8%, and 7%, respectively. A single safety event occurred, yielding a 0.2% event rate (95% upper confidence limit, 1.0%).
  
  
  CONCLUSIONS
  Use of in-bed cycling as part of routine PT interventions in ICU patients is feasible and appears safe. Further study of the potential benefits of early in-bed cycling is needed.
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; School of Rehabilitation Science, McMaster University, Hamilton, ON, L8S 1C7. Electronic address: khome@mcmaster.ca.
authors: Michelle E
authors: ME
authors: Kho
authors: University of Massachusetts Medical School, Worcester, MA, USA.
authors: Robert A
authors: RA
authors: Martin
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
authors: Amy L
authors: AL
authors: Toonstra
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
authors: Jennifer M
authors: JM
authors: Zanni
authors: Division of Pulmonary & Critical Care Medicine, Johns Hopkins University; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
authors: Earl C
authors: EC
authors: Mantheiy
authors: Division of Pulmonary & Critical Care Medicine, Johns Hopkins University; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
authors: Archana
authors: A
authors: Nelliot
authors: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21287; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University; Outcomes After Critical Illness and Surgery, Johns Hopkins University.
authors: Dale M
authors: DM
authors: Needham
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D016552:Ergometry / Q000379:methods*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D061214:Patient Safety; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies
keywords: Artificial; Critical illness; Cycle ergometry; Intensive care units; Muscle; Respiration