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ICU mobility and improved outcomes: still searching for the Holy Grail
  1. Matthew R Stutz,
  2. John P Kress,
  3. Krysta S Wolfe
  1. Department of Medicine, Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Krysta S Wolfe, Pulmonary and Critical Care, University of Chicago Department of Medicine, Chicago, IL MC 6076, USA; Krysta.Wolfe{at}uchospitals.edu

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A growing number of patients are surviving critical illness, many of whom will experience long-term impairments in cognition and physical function. These enduring effects represent a significant burden for patients, their families and society. Unfortunately, interventions aimed at preventing the development of functional or cognitive disability due to critical illness are limited. Strategies to minimise sedation and initiate early physical rehabilitation have been associated with reductions in physical impairment and delirium, but the results of studies have been mixed and the impact on long-term outcomes has not been well established.1 The implementation of rehabilitation with mobilisation within 72 hours of mechanical ventilation has the most promising results, but occurs in less than 10% eligible patients, with barriers, including the availability of trained physiotherapists and the ability of a patient to participate in rehabilitation sessions.2 3 Therefore, there is intense interest in novel rehabilitation strategies to overcome these barriers.

Functional electrical stimulation-assisted cycle ergometry (FES-cycling) combines neuromuscular electrical stimulation (NMES) with in-bed cycling. FES-cycling offers theoretical advantages as it is feasible to integrate early in the course of critical illness, including in non-volitional patients, and mimics typical exercise by coupling the peripheral neuromuscular systems. Prior studies examining the effects of cycling and NMES delivered separately on functional outcomes have been mixed.4 …

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Footnotes

  • Contributors All authors contributed to the writing, critical review and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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