Abstract
Objective
To evaluate the feasibility and safety of exercise testing and to describe the physiological
response to exercise of patients in the Intensive Care Unit (ICU).
Design
A prospective observational multicenter study.
Setting
Two mixed medical-surgical ICUs.
Participants
Patients (N=37; with no primary neurological disorders, 59% men; median age 50y; ICU
length of stay 14.5d; Acute Physiology and Chronic Health Evaluation IV 73.0) who
had been mechanically ventilated for more than 48 hours and were hemodynamically stable
enough to perform physical exercise.
Interventions
A passive or active incremental exercise test, depending on muscle strength, on a
bed-based cycle ergometer.
Main Outcome Measures
Feasibility and safety were evaluated based on protocol adherence and adverse events.
Physiological responses to exercise quantified as changes in respiratory frequency
(RF), oxygen uptake (Vo2), carbon dioxide output (Vco2), respiratory exchange ratio (RER), and blood lactate.
Results
Thirty-seven patients of whom 18 were mechanically ventilated underwent the exercise
test. The active incremental test was performed by 28, and the passive test by 9 participants.
Thirty-three (89%) accomplished the test according to the protocol and 1 moderate
severe adverse event (bradycardia; heart rate 44) occurred shortly after the test.
RF, Vo2, Vco2, and lactate increased significantly, whereas RER did not change during the active
incremental exercise test. No changes were observed during the passive exercise test.
Conclusions
It is safe and feasible to perform exercise testing on a bed-based cycle ergometer
in patients who are critically ill and a physiological response could be measured.
Future research should investigate the clinical value of exercise testing in daily
ICU practice and whether exercise capacity and its limiting factors could be determined
by incremental exercise testing.
Keywords
List of abbreviations:
ICU (intensive care unit), ICU-AW (intensive care unit–acquired weakness), IQR (interquartile range), MRC (Medical Research Council), O2 (oxygen), RER (respiratory exchange ratio), RF (respiratory frequency), RPM (revolutions per minute), SBP (systolic blood pressure), Spo2 (oxygen saturation), Vco2 (carbon dioxide output), Vo2 (oxygen uptake)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 22, 2018
Footnotes
The first 2 authors contributed equally.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
