title: Safety and Feasibility of a Protocolized Approach to In-Bed Cycling Exercise in the Intensive Care Unit: Quality Improvement Project.
abstract: BACKGROUND
  In-bed, supine cycle ergometry as a part of early rehabilitation in the intensive care unit (ICU) appears to be safe, feasible, and beneficial, but no standardized protocol exists. A standardized protocol may help guide use of cycle ergometry in the ICU.
  
  
  OBJECTIVE
  This study investigated whether a standardized protocol for in-bed cycling is safe and feasible, results in cycling for a longer duration, and achieves a higher resistance.
  
  
  METHODS
  A quality improvement (QI) project was conducted.
  
  
  METHODS
  A 35-minute in-bed cycling protocol was implemented in a single medical intensive care unit (MICU) over a 7-month quality improvement (QI) period compared to pre-existing, prospectively collected data from an 18-month pre-QI period.
  
  
  RESULTS
  One hundred and six MICU patients received 260 cycling sessions in the QI period vs. 178 MICU patients receiving 498 sessions in the pre-QI period. The protocol was used in 249 (96%) of cycling sessions. The QI group cycled for longer median (IQR) duration (35 [25-35] vs. 25 [18-30] minutes, P < .001) and more frequently achieved a resistance level greater than gear 0 (47% vs. 17% of sessions, P < .001). There were 4 (1.5%) transient physiologic abnormalities during the QI period, and 1 (0.2%) during the pre-QI period ( P = .031).
  
  
  CONCLUSIONS
  Patient outcomes were not evaluated to understand if the protocol has clinical benefits.
  
  
  CONCLUSIONS
  Use of a protocolized approach for in-bed cycling appears safe and feasible, results in cycling for longer duration, and achieved higher resistance.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine.
authors.forename: Ibtehal
authors.initials: I
authors.lastname: Kimawi
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital.
authors.forename: Bryanna
authors.initials: B
authors.lastname: Lamberjack
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine.
authors.forename: Archana
authors.initials: A
authors.lastname: Nelliot
authors.affiliation: OACIS Group, Johns Hopkins University School of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital.
authors.forename: Amy Lee
authors.initials: AL
authors.lastname: Toonstra
authors.affiliation: OACIS Group, Johns Hopkins University School of Medicine; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zanni
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine.
authors.forename: Minxuan
authors.initials: M
authors.lastname: Huang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine.
authors.forename: Earl
authors.initials: E
authors.lastname: Mantheiy
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kho
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, 5th Floor, Baltimore, MD 21205 (USA); OACIS Group, Johns Hopkins University School of Medicine; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D016552:Ergometry / Q000379:methods*; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D026741:Physical Therapy Modalities; D058996:Quality Improvement; D016896:Treatment Outcome