Ruminations

The ICU Supine Bike

"More and more critical care units are starting to push for early activity, early mobilization, to combat the detrimental effects of being in bed."
Rachel Goard, physiotherapist, Ottawa Hospital

Physiotherapists Josée Lamontagne (left) and Rachel Goard supervised while Respiratory Therapy student Patrick Lapointe demonstrated the specially-designed bicycle at the Ottawa General Campus ICU. courtesy of The Ottawa Hospital

There was a time -- not all that long ago -- when surgical procedures required lengthy hospital stays for recovering patients. They were to be observed by staff while bed-ridden in a hospital setting, to ensure that recovery proceeded as scheduled - or hoped, before they would be released. Even birth deliveries necessitated a week's stay in hospital, fifty years ago. Now? barely a day. Even open-heart surgery currently has doctors ordering that once out of intensive care patients are encouraged to get out of bed briefly to help blood circulation and a more speedy recovery.

Newer surgical techniques such as minimally-invasive surgery made possible with technologically advanced medical instruments and surgical training in the techniques involved are becoming more common, and result in less blood lost, less damage to human tissue, and speedier recovery time. Using of state-of-the-art technology to reduce the damage to human tissue when performing surgery. Rather than making long and deep incisions, for example, the surgeon makes several ¾ inch incisions, then slender tubes called trocars come into use.

The intensive care unit of The Ottawa Hospital is undergoing tests to determine whether critically ill patients, exposed to the opportunity to activate their muscular function while in bed will recover faster, post-surgery. The medium is a specialized bike that can be wheeled up to the patient's bed, to enable patients' feet to produce a cycling motion. The hope is that this will avoid atrophying muscles, a problem of long standing.

Confinement to a bed for prolonged periods of time results in severe muscle weakness. When not used, muscles can atrophy quite quickly. Research indicates that healthy people can lose four to five percent of muscle strength for every week of inactivity. The first ten days, in fact, appears the time when muscle loss is most accelerated. The situation is even worse with the use of mechanical ventilators.

Patients placed on a breathing machine for a week or more will see about 25 percent tending to suffer from intensive care unit-acquired weakness. This debilitating condition can be overcome, but it can take years. Dr. Michelle Kho of McMaster University, the holder of a Canada Research Chair in critical care rehabilitation and knowledge translation is leading a two-year clinical trial among seven medical centres across Ontario, with 60 patient-participants.

The bicycle’s screen shows the patient’s speed and progress, and a cycling avatar keeps patients motivated. (Courtesy of The Ottawa Hospital)

This will represent the largest study of its kind, examining benefits of in-bed cycling throughout a critical care stay. Other clinical studies established conventional physical therapy like stretching, sitting, standing, walking and light exercise for ICU patients as having value in rehabilitation. Patients are scheduled to 30 minutes daily of in-bed cycling with the use of the RT-300 supine bike, along with routine physiotherapy.

Patients' outcomes will be tracked to compare physical capabilities on discharge as compared to patients in the ICU who have received routine physiotherapy exclusively. Muscle strength is to be assessed, as well as the patients' ability to stand and to walk. The purpose of the study is to fully understand whether early intervention in ICU with daily cycling will produce a swifter recovery.

To be observed as well is whether critically ill ICU patients, many of whom are in pain and deeply sedated, can gain from the supervised use of the cycling machine. Some ICU patients are challenged with conditions such as delirium, obesity and irregularities in heart rhythm and blood pressure. Researchers in 2012 at Johns Hopkins University School of Medicine reported "growing evidence" in support of the idea that critically ill patients benefit from early physiotherapy and exercise, as a safe practice.

Even sedated patients at The Ottawa Hospital will be subject to the developing new protocol of some form of physical activity hastening recovery. According to physiotherapist Rachel Goard, the bed bike is equipped with a motor capable of aiding pedal movement for critically ill and sedated patients, even when they're not awake and aware.