Implementing In-bed Cycle Ergometry for Mechanically Ventilated Patients using the Rehabilitation Treatment Specification System

Summary

Protocols for the delivery of in-bed leg cycle ergometry to critically ill patients in the intensive care unit are presented according to the Rehabilitation Treatment Specification System to promote standardization of procedures, ensure patient safety, and support reproducibility across clinical and research settings.

Abstract

In-bed cycle ergometry is a safe, feasible, and reliable method of providing in-bed physical rehabilitation for patients with critical illness in the intensive care unit. It is a complex intervention that requires specific clinical decision-making skills to identify suitable patients, close coordination with the team to deliver the intervention, and ongoing evaluation to guide treatment progression. Protocols for the delivery of in-bed cycle ergometry are presented according to the Rehabilitation Treatment Specification System. Specifically, the components of in-bed leg cycle ergometry are described, including preparation, equipment, therapist actions (instructions and feedback), progression considerations, and clinical decision-making.

Patient selection for in-bed cycle ergometry in the intensive care unit should prioritize physiological stability, with safety criteria for starting and stopping, and defined inclusion and exclusion criteria to support standardized and reproducible delivery. The patient should be in the semi-recumbent position, with the in-bed cycle ergometer secured at the foot of the bed and neutral lower limb alignment maintained. Dosing and progression should consider active or passive modes, frequency, duration, cadence, and resistance. Patient monitoring should include clearly specified physiological and tolerance thresholds, with increases applied systematically. Documentation of treatments following the Rehabilitation Treatment Specification System supports clinical decision-making, standardization, and reproducibility.

Introduction

Physical disability is often a severe and long-lasting consequence of critical illness^1,2. Advances in intensive care medicine have improved survival rates over the last 30 years³. However, there is emerging recognition of the impact of physical impairments experienced by survivors following discharge from the intensive care unit (ICU)⁴. Long-term physical impairments originate from ICU-acquired weakness (ICU-AW), a global, symmetrical neuromuscular weakness related to the ICU admission alone⁵. Factors contributing to the development of IC....

Protocol

All procedures included within this protocol reflect primary studies that adhered to local institutional ethical standards and guidelines. No specific ethical approval was required for this protocol article.

1. Patient selection and presession assessment

1. Identify patients appropriate for in-bed cycle ergometry, considering all contraindications and precautions (Table 1).
2. Perform a multi-system assessment to determine the patients’ neurological status, haemodynamic stability, respiratory stability, and functional ability.
3. Use findings to determine starting mode, duration....

Results

Successful implementation of this protocol of in-bed cycle ergometry will result in a completed physical rehabilitation session of in-bed cycle ergometry that is safe and without adverse events. Typical sessions may commence passively whilst a patient is sedated, unconscious, and unable to participate. The cadence will commence slowly (e.g., 5 RPM) and increase up to 30 RPM, or the patient’s self-selected pace. The duration of sessions will increase over time up to a total of 60 minutes as tolerance increases. Passive se.......

Discussion

In-bed cycle ergometry is a safe, feasible, and reliable therapy option for patients mechanically ventilated in the ICU that improves physical function by ICU and hospital discharge¹⁵.

Applying the RTSS to in-bed cycle ergometry
Figure 2 summarizes examples of targets, mechanisms of action, ingredients, and potential measures for in-bed cycle ergometry. We developed our approach to implementing in-bed cycle ergometry .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
MOTOMed Letto2	RECK-Technik GmbH & Co. KG		info@motomed.com
RT300 Supine	Restorative Therapies, Baltimore, MD		https://restorative-therapies.com