Megan Kupferschmid, CCRN, MSN, RN
OSF St Francis Medical Center
Peoria, Illinois
Disclosure information not submitted.
Samantha Monk, MSN, RN, , CPN (she/her/hers)
Clinical Nurse Educator
OSF St Francis Medical Center
Peoria, Illinois
Disclosure information not submitted.
Kimberly Burkiewicz, ACNP, CPNP, DNP, RN
Acute Care APRN
Children's Hospital of Illinois
Peoria, Illinois
Disclosure information not submitted.
Maureen Welty, DNP, APRN, CPNP-AC
APN
OSF St Francis Medical center, United States
Disclosure information not submitted.
Jamie Poorman, PT, DPT
Physical Therapist
OSF St Francis Medical center, United States
Disclosure information not submitted.
LaMonica Henrekin, BSN, RN, NE-BC
Peds ICU & Peds INT Nurse Manager
OSF Healthcare Children's Hospital of IL
Peoria, Illinois
Disclosure information not submitted.
Jonathan Gehlbach, MD
Physician
University of Illinois College of Medicine - Peoria, United States
Disclosure information not submitted.
Sandeep Tripathi, MD, MS
Associate Professor of Pediatrics
University of Illinois College of Medicine at Peoria
Peoria, Illinois
Disclosure information not submitted.
Title: Pedal out of the PICU: Experience with the use of in-bed cycle ergometer in critically ill children.
Introduction: Emphasis on early mobility for patients in the ICU has been shown to improve patient outcomes. There are limited options for active mobility for children who are unable to ambulate. In-bed cycle ergometer (RT300 supine®, Restorative Therapies, Baltimore, MD) allows weak, paralyzed, or sedated patients to participate in physical therapy. There are, however only a few reports on its practical use and tolerance by children. This study describes our use of RT300 Supine® in critically ill children.
Methods: RT300 Supine® was introduced in the PICU in April 2021 as part of experimental therapy. Patients ≥4 years who are not at baseline functional status, expected to be in PICU for >48 hours and unable to get out of bed for 24 hours were enrolled in the study after informed consent. Enrolled patients performed up to 2 sessions for 5 days in the ICU. Measurements included exercise variables from the ergometer, Functional Status Score (FSS), and dynamometer readings (Lafayette Instruments, Lafayette, IN) at baseline and discharge. Patient and staff workload with the equipment was assessed with the NASA task load index (NASA TLX®).
Results: 29 ergometer sessions were conducted on five patients in the PICU (median age 12.3 years). The median active lower extremity exercise time was 3 (IQR 1.0, 7.3) min (n= 24), and passive exercise time was 9.5 (IQR 4.3, 13.3) min. There were 3 upper extremity sessions with a median active and passive time of 5.0 (IQR 4, 7) and 1.5 (IQR 1.0, 3.0) minutes. The median distance covered during exercise was 1.3 (IQR 0.8, 2.6) miles. Muscle strength increased from a median of 7.8 (IQR 5.7, 9.7) lbs. (n= 50) to 12.1 (IQR 9, 17.7) lbs. (n= 51) at the time of discharge (p< 0.001). The baseline FSS of all patients was normal at 6. The median enrolment baseline was 10 (IQR 9.5, 14), which improved to 8 (IQR 6.5, 9) (p= 0.03) at the time of discharge. The median score on five NASA TLX difficulty domains was 20 (IQR 10, 42.5) for patients and 30 (IQR 20, 50) for PICU staff (on a scale of 0- 100, where 100 is the highest level of difficulty).
Conclusions: In-bed ergometer is well tolerated by children in PICU with minimal increase in staff workload. Even short duration of active exercise while critically ill can lead to improvement in muscle strength and functional status.