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CoronavirusNPIDRA2021NCT06226428

Cyclo-Ergometry in the Patient With Acute Respiratory Distress Syndrome

A study testing Bed cyclo-ergonometry, Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking. and Progressive upper and lower limb strength training in people with Coronavirus, run by Biogipuzkoa Health Research Institute at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In March 2020 the World Health Organization declares the Coronavirus disease pandemic 2019. Intensive Care Units deal entirely with patients with pneumonia complicated by Acute Respiratory Distress Syndrome, requiring aggressive respiratory treatments with long periods of connection to mechanical ventilation, sedation… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Coronavirus
What is being tested?
Bed cyclo-ergonometry, Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking. and Progressive upper and lower limb strength training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
1 siteSpain
Study dates
1 Apr 2021to 18 Dec 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient 18 years of age or older
  • Alert and cooperative (RASS agitation-sedation between -1 and +1).
  • Able to give informed consent (or authorize a family member) to be randomly assigned to receive the cyclo-ergometry program or conventional physiotherapy treatment.
  • With or without connection to mechanical ventilation (via orotracheal tube or tracheostomy).
  • Clinically stable (cardio-vascular, respiratory, neurological).
  • With an inspired oxygen fraction less than or equal to 0.6 and requiring minimal ventilatory support (positive end-expiratory pressure less than or equal to 10 cm H2O).

Who cannot join

  • Patients with pre-existing neuromuscular disease, spinal cord injury, cardiorespiratory arrest, stroke, patients with contraindications for mobility, pregnant women, advanced dementia or patients with life expectancy of less than 6 months or any situation that contraindicates the performance of cycloergometry.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Asociación Instituto Biogipuzkoa

    Donostia / San Sebastian, Guipuzcoa, 20014

Other trials in Spain

About this study

Official title: Ciclo-Ergometría en el Paciente Con Síndrome de Distrés Respiratorio Agudo

In March 2020 the World Health Organization declares the Coronavirus disease pandemic 2019. Intensive Care Units deal entirely with patients with pneumonia complicated by Acute Respiratory Distress Syndrome, requiring aggressive respiratory treatments with long periods of connection to mechanical ventilation, sedation and immobilization, contributing to the onset of acquired critical patient muscle weakness (IAPD). IUCD is a frequent complication in intensive care units, with an incidence of 11-67%¹. Of multifactorial cause, immobilization or "bed-rest", the use of corticosteroids and neuromuscular blocking agents have been described as factors directly related to this syndrome.

Several studies have shown that mobilization of the patient with acute respiratory distress syndrome, even with extracorporeal membrane oxygenation, is safe, feasible and beneficial for the patient. Bedside cyclo-ergometry has been associated with a reduction in the degree of sarcopenia, contributing to the recovery of the critically ill patient. Several studies document that bed cyclo-ergometry is safe and feasible in critically ill patients within the first week of admission to intensive care, but few clinical trials exist.

Read the detailed description

In March 2020 the World Health Organization declares the Coronavirus disease pandemic 2019. Intensive Care Units deal entirely with patients with pneumonia complicated by Acute Respiratory Distress Syndrome, requiring aggressive respiratory treatments with long periods of connection to mechanical ventilation, sedation and immobilization, contributing to the onset of acquired critical patient muscle weakness (IAPD).

IUCD is a frequent complication in intensive care units, with an incidence of 11-67%¹. Of multifactorial cause, immobilization or "bed-rest", the use of corticosteroids and neuromuscular blocking agents have been described as factors directly related to this syndrome. Each additional day of bed rest is associated with a 3 to 11% decrease in the strength of both peripheral and respiratory muscles, which translates into difficulty in weaning from mechanical ventilation, longer stay in the Intensive Care Unit and in the hospital in general, as well as an increase in morbidity and mortality. Similarly, in the first 24 hours after initiation of mechanical ventilation, diaphragmatic atrophy or dysfunction occurs, predisposing to prolonged mechanical ventilation. The need for ventilatory support for more than 48 hours has been associated with greater morbidity and mortality at hospital discharge, and survivors present greater disability and deterioration in their quality of life.

Several studies have shown that mobilization of the patient with acute respiratory distress syndrome, even with extracorporeal membrane oxygenation, is safe, feasible and beneficial for the patient. Most of the programs described in the literature include patients requiring extracorporeal membrane oxygenation, mainly in the pre-transplantation situation, and to a lesser extent patients with acute respiratory distress syndrome. They are characterized by the individual and progressive performance of functional activities of lesser to greater difficulty, starting with passive exercises of joint range, active and active-resisted exercises while the patients are in decubitus, progressing in some cases to sitting at the edge of the bed and less frequently to standing.

Bedside cyclo-ergometry has been associated with a reduction in the degree of sarcopenia, contributing to the recovery of the critically ill patient. Several studies document that bed cyclo-ergometry is safe and feasible in critically ill patients within the first week of admission to intensive care, but few clinical trials exist.

Conditions
Coronavirus
Being tested
Bed cyclo-ergonometry, Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking., Progressive upper and lower limb strength training
Keywords
Corticosteroids, Mobilization, Oxygenation, Cyclo-ergonometry, Acquired muscle weakness of the critically ill patient
Medical subject headings
Coronavirus Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bed cyclo-ergonometryOther

    The MotoMed Letto 2 device will be used, with a progressive pattern, starting at 5 minutes and lasting up to 30 minutes. It will be performed once a day, during weekdays (Monday to Friday) until discharge from the intensive care unit, and at a modified Borg intensity of 2-3 (Light).

  • Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking.Other

    Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking.

  • Progressive upper and lower limb strength trainingOther

    Performing isometric exercises, strengthening with multi-resistance elastic bands or multi-weight dumbbells.

Study groups in NCT06226428
Study groupRoleWhat they receive
Cyclo-ergonometry program groupExperimental* Mobility activities in bed (turning, pelvic elevation and sitting), standing, transfers and walking. * Progressive strength training of upper and lower limbs (2 days/week), by performing isometric exercises, strengthening with multi-resistance elastic bands or multi-weight dumbbells. * Cycloergometry, using the MotoMed Letto 2 device, with a progressive pattern, starting with 5 minutes and lasting up to 30 minutes. It will be performed once a day, during working days (Monday to Friday) until discharge from the intensive care unit, and at a modified Borg intensity of 2-3 (Light).
Receives: Other: Bed cyclo-ergonometry; Other: Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking.; Other: Progressive upper and lower limb strength training
Usual treatment groupActive comparator* Mobility activities in bed (turning, pelvic elevation and sitting), standing, transfers and walking. * Progressive strength training of upper and lower limbs (2 days/week), by performing isometric exercises, strengthening with multi-resistance elastic bands or multi-weight dumbbells.
Receives: Other: Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking.; Other: Progressive upper and lower limb strength training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. CLINICAL ENDPOINT Age: Years completed at the time of inclusion in the study.

    Continuous quantitative variable.

    Measured: Until discharge from the intensive care unit

  2. CLINICAL ENDPOINT Sex: Dichotomous qualitative variable

    . Categories: Female/Male.

    Measured: Until discharge from the intensive care unit

  3. CLINICAL ENDPOINT Length of stay in the Intensive Care Unit: Number of days elapsed between admission and discharge from Intensive Care.

    Continuous quantitative variable.

    Measured: Until discharge from the intensive care unit

  4. CLINICAL ENDPOINT Overall length of stay in hospital: Number of days between admission and discharge.

    Continuous quantitative variable.

    Measured: Until discharge from the intensive care unit

  5. CLINICAL ENDPOINT Mechanical ventilation time:Number of days between intubation and successful weaning (defined as 48 hours of spontaneous breathing).

    Continuous quantitative variable.

    Measured: Until discharge from the intensive care unit

  6. CLINICAL ENDPOINT Adverse events: Defined as the presence during or within 10 minutes of cyclo-ergometry of any of the following.

    Discrete qualitative variable.

    Loss of airway or venous/arterial lines. Increased vasoactive drug dosage: more than 5 mcg/min Increase in blood pressure: above 200 mmHg for more than 2 minutes. Drop in mean arterial blood pressure: below 60 mmHg for more than 2 minutes. Heart rate: below 50 bpm or above 140 bpm for more than 2 minutes. Drop in arterial oxygen saturation: below 88% for more than one minute requiring increasing the inspired oxygen fraction by more than 1% for more than 5 minutes.

    Measured: Until discharge from the intensive care unit

  7. FUNCTIONAL ENDPOINT Gait capacity: Measured by the 6-minute walk test at the time of discharge from hospital. A simple and inexpensive physical capacity test.

    It reflects the level of physical activity in daily activities. It consists of walking as far as possible in 6 minutes, at a brisk pace without running, over a distance of about 30 metres. The main result is the distance covered and is recorded in metres. Arterial oxygen saturation and heart rate are monitored during the test. Available evidence suggests a minimum significant difference of 30 metres (25-33 metres) for adult patients with chronic respiratory disease.

    Measured: Until discharge from the intensive care unit

  8. FUNCTIONAL ENDPOINT Functional capacity: Measured at discharge from the Intensive Care Unit and at hospital discharge.

    By performing the Short Physical Performance Battery (SPPB)³, a test consisting of 3 items: balance, gait speed and getting up and sitting in a chair 5 times. It assesses balance, gait ability and lower limb strength. The total score ranges from 0 (worst) to 12 points (best). The SSPB has been shown to be a valid instrument for detecting frailty and predicting disability, institutionalisation and mortality. A total score of less than 10 indicates frailty and a high risk of disability and falls. A 1-point change in score has clinical relevance.

    Measured: Until discharge from the intensive care unit

  9. FUNCTIONAL ENDPOINT Peripheral muscle strength on admission-discharge from ICU and hospital discharge.

    Measurement of muscle strength using the Medical Research Council manual scale and using a dynamometer on admission and discharge from Intensive Care, as well as on discharge from hospital.

    Measured: Until discharge from the intensive care unit

  10. FUNCTIONAL ENDPOINT ICU MOBILITY SCALE (Spanish adaptation)

    A valid and reliable scale that assesses the mobility of critically ill patients and helps to plan individualised activity programmes to prevent acquired muscle weakness in the critically ill patient.

    Measured: Until discharge from the intensive care unit

  11. FUNCTIONAL ENDPOINT Modified Borg Scale

    Subjective assessment of perceived dyspnoea and fatigue during the training session.

    Measured: Until discharge from the intensive care unit

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Jan 2024
  2. Study start1 Apr 2021
  3. Primary completion18 Feb 2022
  4. Study completion18 Dec 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
Controlled pilot clinical trial, with randomized assignment to two treatment groups, the cyclo-ergometry program group and the usual treatment group (parallel). The randomization will be carried out by blocks and will be kept in the Clinical Epidemiology Unit. When the physician has a patient available to enter the study, a call will be made to the Clinical Epidemiology Service where a randomization code and the group to which he/she has been assigned will be indicated.
Masking
None (open label)
Enrolment
35 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06226428
Sponsor's protocol ID
MUGI-cu
Acronym
NPIDRA2021
Status last verified
Dec 2023
First submitted
5 Jan 2024
Last updated
1 Feb 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Bed cyclo-ergonometry, Bed mobility activities (turning, pelvic elevation and sitting), standing, transfers and walking. and Progressive upper and lower limb strength training in people with Coronavirus, run by Biogipuzkoa Health Research Institute at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

CLINICAL ENDPOINT Age: Years completed at the time of inclusion in the study. (time frame: Until discharge from the intensive care unit). The study lists 11 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Feb 2024.

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