Effect of In-Bed Cycling in the Intensive Care Unit on Patient Outcomes

Introduction: Physical activity in complex medical-surgical ICU patients can be limited. Critical illness myopathy and ICU-acquired weakness are associated with prolonged bedrest; corresponding to longer ICU stays, increased time on mechanical ventilation, and mortality. Functional limitations and post-intensive care syndrome can persist for years. Early ICU mobility is associated with improved strength, overall function, and is a component of the evidence-based ABCDEF Bundle. In-bed cycling is a new and potential intervention to mitigate the effects of ICU hospitalization. Initial research supports the safety and feasibility of in-bed cycling exercise and potentially improves outcomes. Could implementation of an in-bed cycling program improve ICU patient outcomes?


Methods: A signal center retrospective analysis of in-bed cycling program. ICU patients admitted for at least 24 hours with cycling compared to non-cycling. Primary endpoints: length of ICU and hospital stay, duration of mechanical ventilation, delirium rate, iatrogenic infection. Secondary endpoints: discharge disposition and 30-day readmission. Matching was used to control for various patient characteristics on outcomes of interest.


Results: 88 cases of in-bed cycling met inclusion criteria and were matched to a non-cycling control group of 176 cases (264 cases). 69% male. Median age 67 years. Median time to cycling of 1.29 days from ICU admission (IQR 0.84-2.25 days). Statistical differences were observed between cycling and non-cycling for median ICU length of stay (2.4 and 2.0, respectively. P=0.004) and median hospital length of stay (P < 0.001). No statistical difference occurred between groups for duration of mechanical ventilation (P>0.9), delirium rate (P=0.8), iatrogenic infection rate (P=0.3). Discharge disposition was significantly different between cycling and non-cycling (P=0.027). The cycling group was less likely to discharge with skilled assistance (20% v 27%) and less likely to expire (6.8% v 18%). 30-day readmission was not significantly different between groups (P=0.5).


Conclusions: In this study, incorporation of bed bike mobilization during ICU admission decreased the needs for skilled nursing at discharge. Bed bike ICU mobilization may play a critical role in influencing discharge needs and mortality.