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

Inclusion Criteria:

1. >=18 years old

2. Requiring mechanical ventilation or high flow nasal cannula (HFNC) with actual or
expected total duration of mechanical ventilation or HFNC >48 hours

3. Expected ICU stay >4 days after enrollment (to permit adequate exposure to the
proposed intervention)

Exclusion Criteria:

1. >120 continuous hours of mechanical ventilation or HFNC before enrollment

2. Expected death or withdrawal of life-sustaining treatments within 7 days from
enrollment

3. No expectation for any nutritional intake within the subsequent 72 hours

4. Severe chronic liver disease (MELD score >20) or acute fulminant hepatitis.

5. Documented allergy to the amino acid intervention

6. Not ambulating independently prior to ICU admission (use of gait aid permitted)

7. Pre-existing primary systemic neuromuscular disease (e.g. Guillain Barre)

8. Neuromuscular blocker infusion (eligible once infusion discontinued if other inclusion
criteria met)

9. Pre-existing intracranial or spinal process affecting motor function

10. Pre-existing cognitive impairment or language barrier that prohibits outcomes
assessment

11. Lower extremity impairments that prevent cycling (e.g. amputation, knee/hip injury)

12. Weight >150kg

13. Pregnant

14. Incarcerated