A Pilot Study of Combined Cycle Ergometry and Amino Acids in the ICU

Inclusion criteria

• >=18 years old
• Requiring mechanical ventilation or high flow nasal cannula (HFNC) with actual or expected total duration of mechanical ventilation or HFNC >48 hours
• Expected ICU stay >4 days after enrollment (to permit adequate exposure to the proposed intervention)

Exclusion criteria

• >120 continuous hours of mechanical ventilation or HFNC before enrollment
• Expected death or withdrawal of life-sustaining treatments within 7 days from enrollment
• No expectation for any nutritional intake within the subsequent 72 hours
• Severe chronic liver disease (MELD score >20) or acute fulminant hepatitis.
• Documented allergy to the amino acid intervention
• Not ambulating independently prior to ICU admission (use of gait aid permitted)
• Pre-existing primary systemic neuromuscular disease (e.g. Guillain Barre)
• Neuromuscular blocker infusion (eligible once infusion discontinued if other inclusion criteria met)
• Pre-existing intracranial or spinal process affecting motor function
• Pre-existing cognitive impairment or language barrier that prohibits outcomes assessment
• Lower extremity impairments that prevent cycling (e.g. amputation, knee/hip injury)
• Weight >150kg
• Pregnant
• Incarcerated