Skip to main content

Table 1 Daily cycling exemption and cycling termination criteria

From: CardiO Cycle: a pilot feasibility study of in-bed cycling in critically ill patients post cardiac surgery

Daily cycling exemptions
 Use of 4 or more inotropes or vasopressors
 Any increased titration of inotropic medication in the past 2 h
 Active myocardial ischemia as confirmed by bedside 12-lead electrocardiogram (ECG)
 Mean arterial pressure (MAP) < 60 mmHg or > 110 mmHg
 Heart rate < 40 bpm or > 140 bpm within the past 2 h
 New onset of uncontrolled atrial fibrillation with a rate greater than 130 beats/min
 Persistent SpO2 less than 88%, or out of what is typical for the patient, within the last 2 h
 Use of neuromuscular blockade within the past 4 h
 Severe agitation, as measured by the Richmond Agitation and Sedation Scale (score > 2)
 Presence of an intra-aortic balloon pump or femoral sheath
 Insertion of a temporary pacemaker (transvenous pacemaker) or those who are paced externally with no underlying rhythm
 Unstable saphenous vein graft site(s)
 Change in goals of care to palliation
 Patient or proxy refusal
 Team perception that cycling is not appropriate despite lack of listed exemption criteria
Cycling termination criteria
 Sustained decrease in oxygen saturation of < 88% for > 2 min despite attempts to improve oxygenation (increasing FiO2, tracheal suctioning)
 Patient or proxy refusal after 2 attempts at encouragement to continue
 Unplanned extubation or decannulation
 Dehiscence of saphenous vein graft incision site(s)
 Sudden onset of severe agitation (Richmond Agitation and Sedation Scale (score > 2))
 Concerns for new onset of cardiac ischemia as per continuous telemetry
 Sudden onset of cardiac arrhythmias (including bradycardia < 40 bpm, tachycardia > 140 bpm, atrial fibrillation, right or left bundle branch block, sustained ventricular tachycardia, ventricular fibrillation, bigeminy, trigeminy)
 Hypotension with a systolic blood pressure < 90 mmHg
 Accidental removal of any lines or tubes (i.e., chest tubes, Jackson-Pratt drain, arterial line)