Cycle ergometry reduces ICU stays and improves recovery in critically ill patients

by · News-Medical

Early in-bed cycle ergometry can shorten ICU stays and enhance physical function in critically ill patients, offering a safe and effective rehabilitation strategy for quicker recovery.

A study finds that cycling with critically ill patients may reduce the length of stay in the ICU or hospital and improve physical function at ICU or hospital discharge without affecting other outcomes, including mortality. However, these findings are based on low to very low certainty of evidence, which tempers the strength of the conclusions.

A recent European Society of Intensive Care Medicine study aimed to summarize and systematically review existing evidence on the safety and efficacy of cycle ergometry in the intensive care unit (ICU).

Physical rehabilitation interventions and cycle ergometry 

Diverse global research: The study analyzed data from 33 trials conducted across 13 countries, with over 3,200 critically ill patients involved, showcasing the international scope of the research.

About the study

RCTs of adults who were critically ill and admitted to the ICU for more than 24 hours were included. Cycling interventions (as part of a multifaceted strategy or in isolation) were compared to other interventions that did not include cycling. Besides the focus on physical function, other factors were considered, such as muscle strength, duration of mechanical ventilation, ICU-acquired weakness (ICUAW), length of hospital stay, mortality, and so on.

Outcomes were documented at three points in time: discharge from the ICU, hospital discharge, and the nearest measure post–hospital discharge. For each time period, all functional measures were identified across included trials, which led to the detection of the most common outcome at that time point. For multiple physical functional outcome reports, the one related to the cycling intervention was selected.

Study findings

A total of 33 trials between 1998 and 2024 were included, with 3274 critically ill patients enrolled. Among these, 1648 were allocated to cycling, while the remaining were allocated to control. The trials were conducted in thirteen countries, were mostly single centers, and had an average sample size of 74. Four trials examined cycling alone, eleven examined cycling plus usual physiotherapy, three assessed cycling plus electrical stimulation and usual physiotherapy, and fifteen examined cycling as part of a multicomponent intervention.

Inconsistent functional outcomes: Although cycle ergometry improved physical function at ICU discharge, its effects on functional recovery at hospital discharge were less clear due to variability in reported outcomes.

Results from twelve and eight RCTs showed that cycling improved physical function at ICU discharge and post-hospital discharge, respectively. No distinction could be made between the efficacy of cycling alone or as part of a multicomponent intervention. In 29 trials, cycling decreased the length of ICU stay, and in 22 trials, it reduced the length of hospital stay. Despite these positive findings, the evidence for most outcomes was classified as low to very low certainty, which means further research may alter the results.

Conclusions

In sum, this study documented that cycling could improve physical function among critically ill patients at ICU discharge and after hospital discharge. Additionally, cycling could reduce the length of ICU and hospital stays without influencing other outcomes such as mortality. However, it is important to recognize that the findings are based on evidence with low certainty, particularly for functional outcomes at hospital discharge.

The study's strengths revolve around including the most recently published and most extensive trials of in-bed cycling in critically ill patients. Furthermore, the methods used were robust, and results were transparently reported to aid replication. Nonetheless, limitations include the lack of universally agreed-upon outcome measures, the variability in how usual care in control groups was described, and the small number of multicenter trials, especially in low-income countries.

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