In March 2020 the World Health Organization declares the Coronavirus disease pandemic2019. Intensive Care Units deal entirely with patients with pneumonia complicated byAcute Respiratory Distress Syndrome, requiring aggressive respiratory treatments withlong periods of connection to mechanical ventilation, sedation and immobilization,contributing to the onset of acquired critical patient muscle weakness (IAPD). IUCD is afrequent complication in intensive care units, with an incidence of 11-67%¹. Ofmultifactorial cause, immobilization or "bed-rest", the use of corticosteroids andneuromuscular blocking agents have been described as factors directly related to thissyndrome.Several studies have shown that mobilization of the patient with acute respiratorydistress syndrome, even with extracorporeal membrane oxygenation, is safe, feasible andbeneficial for the patient. Bedside cyclo-ergometry has been associated with a reductionin the degree of sarcopenia, contributing to the recovery of the critically ill patient.Several studies document that bed cyclo-ergometry is safe and feasible in critically illpatients within the first week of admission to intensive care, but few clinical trialsexist.
In March 2020 the World Health Organization declares the Coronavirus disease pandemic
2019. Intensive Care Units deal entirely with patients with pneumonia complicated by
Acute Respiratory Distress Syndrome, requiring aggressive respiratory treatments with
long periods of connection to mechanical ventilation, sedation and immobilization,
contributing to the onset of acquired critical patient muscle weakness (IAPD).
IUCD is a frequent complication in intensive care units, with an incidence of 11-67%¹. Of
multifactorial cause, immobilization or "bed-rest", the use of corticosteroids and
neuromuscular blocking agents have been described as factors directly related to this
syndrome. Each additional day of bed rest is associated with a 3 to 11% decrease in the
strength of both peripheral and respiratory muscles, which translates into difficulty in
weaning from mechanical ventilation, longer stay in the Intensive Care Unit and in the
hospital in general, as well as an increase in morbidity and mortality. Similarly, in the
first 24 hours after initiation of mechanical ventilation, diaphragmatic atrophy or
dysfunction occurs, predisposing to prolonged mechanical ventilation. The need for
ventilatory support for more than 48 hours has been associated with greater morbidity and
mortality at hospital discharge, and survivors present greater disability and
deterioration in their quality of life.
Several studies have shown that mobilization of the patient with acute respiratory
distress syndrome, even with extracorporeal membrane oxygenation, is safe, feasible and
beneficial for the patient. Most of the programs described in the literature include
patients requiring extracorporeal membrane oxygenation, mainly in the pre-transplantation
situation, and to a lesser extent patients with acute respiratory distress syndrome. They
are characterized by the individual and progressive performance of functional activities
of lesser to greater difficulty, starting with passive exercises of joint range, active
and active-resisted exercises while the patients are in decubitus, progressing in some
cases to sitting at the edge of the bed and less frequently to standing.
Bedside cyclo-ergometry has been associated with a reduction in the degree of sarcopenia,
contributing to the recovery of the critically ill patient. Several studies document that
bed cyclo-ergometry is safe and feasible in critically ill patients within the first week
of admission to intensive care, but few clinical trials exist.
Other: Bed cyclo-ergonometry
The MotoMed Letto 2 device will be used, with a progressive pattern, starting at 5
minutes and lasting up to 30 minutes. It will be performed once a day, during weekdays
(Monday to Friday) until discharge from the intensive care unit, and at a modified Borg
intensity of 2-3 (Light).
Other: Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking.
Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and
walking.
Other: Progressive upper and lower limb strength training
Performing isometric exercises, strengthening with multi-resistance elastic bands or
multi-weight dumbbells.
Inclusion Criteria:
- Patient 18 years of age or older
- Alert and cooperative (RASS agitation-sedation between -1 and +1).
- Able to give informed consent (or authorize a family member) to be randomly assigned
to receive the cyclo-ergometry program or conventional physiotherapy treatment.
- With or without connection to mechanical ventilation (via orotracheal tube or
tracheostomy).
- Clinically stable (cardio-vascular, respiratory, neurological).
- With an inspired oxygen fraction less than or equal to 0.6 and requiring minimal
ventilatory support (positive end-expiratory pressure less than or equal to 10 cm
H2O).
Exclusion Criteria:
- Patients with pre-existing neuromuscular disease, spinal cord injury, cardiorespiratory
arrest, stroke, patients with contraindications for mobility, pregnant women, advanced
dementia or patients with life expectancy of less than 6 months or any situation that
contraindicates the performance of cycloergometry.
Asociación Instituto Biogipuzkoa
Donostia / San Sebastian 3110044, Guipuzcoa, Spain
Not Provided