Feasibility of exercise testing in patients who are critically ill: a prospective, observational multicenter study

Publication date: Available online 22 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Juultje Sommers, Emily Klooster, Siebrand B. Zoethout, Huub LA. van den Oever, Frans Nollet, Robert Tepaske, Janneke Horn, Raoul HH. Engelbert, Marike van der Schaaf

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% male; median age 50 years; ICU length of stay 14.5 days; APACHE 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), 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 one moderate severe adverse event (bradycardia; heart rate 44) occurred shortly after the test. Rf, VO_{2 ,} 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.

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