Effect Of Very Early Bedside Cycling Exercise On ICU-acquired Weakness In Critically Ⅲ Patients With Mechanical Ventilation

Background:Patients with mechanical ventilation in ICU often suffer from muscle decomposition and decrease of synthesis due to many factors,resulting in muscle atrophy and ICU-acquired weakness.ICU-acquired weakness is a common neuromuscular complication in ICU patients,which can affect patients’ physical function and prognosis.Bedside bicycle can reduce muscle atrophy and strengthen patients’ muscle strength by driving patients to perform eccentric contraction of muscles.However,studies have shown that early bedside cycling exercise in the ICU is not effective in preventing ICU-acquired weakness.ICU-acquired weakness occurs early,and muscle atrophy in mechanically ventilated patients has occurred within 24-72 hours of admission to ICU.The time of starting exercise may be an important factor that affects the occurrence of ICU-acquired weakness.Therefore,it is necessary to advance the time of starting early exercise to explore the effect of very early bedside cycling exercise on ICU-acquired weakness and muscle atrophy,and provide a reference for clinical bedside cycling exercise.Objectives:To compare the differences in the incidence of ICU-acquired weakness and muscle atrophy rate between mechanical ventilation patients with very early bedside cycling exercise and mechanical ventilation patients with early bedside cycling exercise.Methods:This study was designed as a quasi-experimental study.From March 1,2019 to March 1,2020,the convenience sampling method was adopted to select 68 ICU mechanically ventilated patients who were treated in the intensive care unit of a comprehensive tertiary hospital in Beijing as the research object.The 34 subjects included from March 1,2019 to August 31,2019 were the control group which received early bedside cycling exercise and routine nursing intervention.And 34 subjects included from September 1,2019 to March 1,2020 were the intervention group which received very early bedside cycling exercise and routine nursing intervention.Patients were diagnosed with ICU-acquired weakness using the MRC muscle strength scale when exiting the ICU.On the 1st,3rd,and 5th days of admission to ICU and the day of leaving ICU,the cross-sectional area and thickness of the rectus femoris muscle and the thickness of the intermediate femoral muscle were measured using ultrasound to evaluate the muscle atrophy rate.Results:A total of 63 subjects were collected,30 in the intervention group and 33 in the control group.The results of the study showed that:(1)Mechanical ventilation patients in the intervention group started very early bedside cycling exercise at 20.17(18.29,27)hours into the ICU,patients in the control group started early bedside cycling exercise at 115.67(90.50,161.00)hours,and no adverse events occurred during the exercise;(2)The number of ICU-acquired weakness in the intervention group was significantly less than that in the control group(P<0.05).(3)The atrophy rate of the rectus femoris cross-sectional area,thickness,and thickness of the intermediate femoral muscle in the intervention group on the 3rd,5th day of admission to ICU and the day out of ICU was significantly smaller than that of the control group(P<0.05).Conclusion:It is safe and feasible to carry out very early bedside cycling exercise in ICU,which can slow muscle atrophy,and prevent ICU-acquired weakness in critically ill patients with mechanical ventilation.