title: TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients.
abstract: BACKGROUND
  The objective of this study was to assess the safety and feasibility of in-bed cycling started within the first 4 days of mechanical ventilation (MV) to inform a future randomized clinical trial.
  
  
  METHODS
  We conducted a 33-patient prospective cohort study in a 21-bed adult academic medical-surgical intensive care unit (ICU) in Hamilton, ON, Canada. We included adult patients (≥ 18 years) receiving MV who walked independently pre-ICU. Our intervention was 30 minutes of in-bed supine cycling 6 days/week in the ICU. Our primary outcome was Safety (termination), measured as events prompting cycling termination; secondary Safety (disconnection or dislodgement) outcomes included catheter/tube dislodgements. Feasibility was measured as consent rate and fidelity to intervention. For our primary outcome, we calculated the binary proportion and 95% confidence interval (CI).
  
  
  RESULTS
  From 10/2013-8/2014, we obtained consent from 34 of 37 patients approached (91.9%), 33 of whom received in-bed cycling. Of those who cycled, 16(48.4%) were female, the mean (SD) age was 65.8(12.2) years, and APACHE II score was 24.3(6.7); 29(87.9%) had medical admitting diagnoses. Cycling termination was infrequent (2.0%, 95% CI: 0.8%-4.9%) and no device dislodgements occurred. Cycling began a median [IQR] of 3 [2, 4] days after ICU admission; patients received 5 [3, 8] cycling sessions with a median duration of 30.7 [21.6, 30.8] minutes per session. During 205 total cycling sessions, patients were receiving invasive MV (150 [73.1%]), vasopressors (6 [2.9%]), sedative or analgesic infusions (77 [37.6%]) and dialysis (4 [2.0%]).
  
  
  CONCLUSIONS
  Early cycling within the first 4 days of MV among hemodynamically stable patients is safe and feasible. Research to evaluate the effect of early cycling on patient function is warranted.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01885442.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.|Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.|Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michelle E
authors.identifier: http://orcid.org/0000-0003-3170-031X
authors.initials: ME
authors.lastname: Kho
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Molloy
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: France J
authors.initials: FJ
authors.lastname: Clarke
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Daana
authors.initials: D
authors.lastname: Ajami
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Magda
authors.initials: M
authors.lastname: McCaughan
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Kristy
authors.initials: K
authors.lastname: Obrovac
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Murphy
authors.affiliation: Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Camposilvan
authors.affiliation: Department of Medicine, University of Toronto, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Herridge
authors.affiliation: Swedish Early Mobility Program in Critical Care, First Hill Campus, Swedish Medical Group, Seattle, Washington.|Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Karen K Y
authors.initials: KK
authors.lastname: Koo
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Rudkowski
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Seely
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zanni
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: Respiratory Therapy Service, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Piraino
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
mesh_terms: D000368:Aged; D004868:Equipment Failure; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation; D012449:Safety