Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients

作者：Michelle E. Kho, Susan C. Berney, Amy M. Pastva, Laurel Kelly, Julie C. Reid, Karen E. A. Burns, Andrew Seely, Frédérick D’Aragon, Bram N. Rochwerg, Ian Michael Ball, Alison Fox‐Robichaud, Tim Karachi, François Lamontagne, Patrick Michel Archambault, Jennifer L. Y. Tsang, Erick Huaileigh Duan, John Muscedere, Avelino C. Verceles, Karim Serri, Shane W. English, Brenda K. Reeve, Sangeeta Mehta, Jill C. Rudkowski, Diane Heels‐Ansdell, Heather K. O’Grady, Geoff Strong, Kristy Obrovac, Daana Ajami, Laura Camposilvan, Jean‐Éric Tarride, Lehana Thabane, Margaret S. Herridge, Deborah J. Cook · 发表于：NEJM Evidence · 年份：2024 · DOI：10.1056/evidoa2400137 · 被引用次数：44 · 研究领域：Intensive Care Unit Cognitive Disorders、Sepsis Diagnosis and Treatment、Frailty in Older Adults

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: 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: 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 di...