Thread by @WellingtonICU

This week's @WellingtonICU #Twitterjournal club was prepared by Eamonn Deverall
bmjopenrespres.bmj.com/content/6/1/e0…

This small pilot RCT looked at the feasibility of running a wider RCT randomising ventilated patients to in-bed cycling and physio vs. routine physio

In addition to possible gains from early physical mobilisation (see TEAM teamtrial.org.au/background), the distraction for patients trapped on a ventilator may be welcome relief.

Participants needed to be independently mobile at baseline, and be randomised within the first 4 days of ventilation.

Exclusions were inability to receive cycling (eg leg fractures), neuromuscular weakness, temporary pacemaker, pregnancy or palliation

Allocation was via block randomisation, to 30min/day cycling + routine physio, or routine physio alone, until 28 days or discharge. 66 patients were randomised.

Just like at the Olympics and the Tour de France, being on powerful drugs was no barrier to participation – 66.7% of the cyclists were on pressors or inotropes.

285 of 864 screened were excluded as not enrolled within 4 days

Physiotherapy time was also a problem, as 123/190 eligible were not randomised due to physio capacity factors.

For those who were randomised to cycling, 94.4% received the intervention, and cycled on 79% of all eligible days. 78.8% of cycling sessions reached 30min. There was no difference in duration of routine physio between groups.

Happily for all concerned, there were no femoral line dislodgements, accidental extubations or myocardial ischaemic events in either arm. I’m not sure if anyone was forced to wear lycra.

The authors looked at the reasons cycling did not occur. For days where there was no medical reason to not cycle, again the main factor was a lack of physio capacity.

Of declined cycling days, 7.6% were from the patient declining compared with only 0.5% from family.

No difference was found in mortality or length of stay outcomes between groups (but this was a feasibility pilot). No differences were found in the discharge assessments either.

The authors concluded that a formal RCT is feasible, needs significantly more
physio capacity and ability to capture participants within time.

They also planned to assess physical function at ICU discharge as opposed to at hospital discharge, as RECOVER showed that an earlier functional status has more prognostic value on one-year mortality (ncbi.nlm.nih.gov/pubmed/26974173).

A follow-up RCT (CYCLIST) has been registered with the Australian and NZ Clinical Trial Registry and is now recruiting in Brisbane. bmjopen.bmj.com/content/7/10/e…

The primary outcome for this trial will be rectus femoris mass at day 10 compared to baseline, with functional status, QOL and mortality among secondary analyses.

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