Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients.

Journal

NEJM evidence
ISSN: 2766-5526
Titre abrégé: NEJM Evid
Pays: United States
ID NLM: 9918317485806676

Informations de publication

Date de publication:
12 Jun 2024
Historique:
medline: 12 6 2024
pubmed: 12 6 2024
entrez: 12 6 2024
Statut: aheadofprint

Résumé

Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).

Sections du résumé

BACKGROUND BACKGROUND
Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment.
METHODS METHODS
We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function).
RESULTS RESULTS
Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29).
CONCLUSIONS CONCLUSIONS
Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).

Identifiants

DOI: 10.1056/EVIDoa2400137 PMID: 38865147
pubmed: 38865147
doi: 10.1056/EVIDoa2400137
doi:

Banques de données

ClinicalTrials.gov
['NCT02377830', 'NCT03471247']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

EVIDoa2400137

Auteurs

Michelle E Kho (ME)

School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Susan Berney (S)

Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia.
Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.

Amy M Pastva (AM)

Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC.

Laurel Kelly (L)

Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Julie C Reid (JC)

School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Karen E A Burns (KEA)

Interdepartmental Division of Critical Care, University of Toronto, Toronto.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto.

Andrew J Seely (AJ)

Department of Surgery, University of Ottawa, Ottawa.
Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa.

Frédérick D'Aragon (F)

Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.

Bram Rochwerg (B)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Ian Ball (I)

Department of Medicine, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.

Alison E Fox-Robichaud (AE)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.

Tim Karachi (T)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Francois Lamontagne (F)

Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.

Patrick M Archambault (PM)

Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada.
Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.

Jennifer L Tsang (JL)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada.

Erick H Duan (EH)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

John Muscedere (J)

Queen's University, Kingston, ON, Canada.
Department of Critical Care Medicine, Kingston, ON, Canada.

Avelino C Verceles (AC)

Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore.

Karim Serri (K)

Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal.

Shane W English (SW)

Department of Medicine (Critical Care), University of Ottawa, Ottawa.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa.

Brenda K Reeve (BK)

Department of Medicine, Brantford General Hospital, Brantford, ON, Canada.

Sangeeta Mehta (S)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto.
Department of Medicine, Sinai Health System, Toronto.

Jill C Rudkowski (JC)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Diane Heels-Ansdell (D)

Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Heather K O'Grady (HK)

School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Geoff Strong (G)

School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Kristy Obrovac (K)

Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Daana Ajami (D)

Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Laura Camposilvan (L)

Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Jean-Eric Tarride (JE)

Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.

Lehana Thabane (L)

Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Research Institute of St. Joe's, Hamilton, ON, Canada.

Margaret S Herridge (MS)

Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto.

Deborah J Cook (DJ)

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Classifications MeSH