***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The study of the peripheral skeletal muscle function in patients with chronic obstructive pulmonary disease ( COPD ) is of growing interest , but often requires biopsies , usually with the Bergström technique . The current study was design ed to test the validity of a minimally invasive technique : the microbiopsy . In 17 patients with COPD and four normal subjects , two specimens of the vastus lateralis were taken percutaneously under local anaesthesia , one with a 16-gauge needle ( microbiopsy ) and the other with the Bergström needle .  The enzymatic activity of citrate synthase ( CS ) and phosphofructokinase ( PFK ) , and the myosin heavy chain ( MyoHC ) composition were measured for both techniques . The subjects reported no pain or much less with the microbiopsy compared with the Bergström biopsy . The microbiopsy sample weight reached 55±17 mg . The two techniques showed excellent agreement for CS activity and MyoHC composition . The PFK activity did not differ statistically between the techniques , but the agreement was moderate . The agreement between both biopsy techniques was stable over time . The median ( range ) fibre number within the microbiopsy specimens was 144 ( 38–286 ) . In conclusion , the current study shows the feasibility and validity of a minimally invasive muscle biopsy technique that appears more comfortable for subjects , compared with the Bergström technique The aim of this study was to investigate the effects of mobilisation on respiratory and haemodynamic variables in the intubated , ventilated abdominal surgical patient .  Mobilisation was defined as the progression of activity from supine , to sitting over the edge of the bed , st and ing , walking on the spot for one minute , sitting out of bed initially , and sitting out of bed for 20 minutes . Seventeen patients with age ( mean + /- SD ) 71.4 + /- 7.1 years satisfied inclusion criteria .  Respiratory and haemodynamic parameters were measured in each of the above positions and compared with supine . In the 15 subjects who completed the protocol , st and ing result ed in significant increases in minute ventilation ( VE ) from 15.1 + /- 3.1 l/min in supine to 21.3 + /- 3.6 l/min in st and ing ( p < 0.001 ) . The increase in VE in st and ing was achieved by significant increases in tidal volume ( VT ) from 712.7 + /- 172.8 ml to 883.4 + /- 196.3 ml ( p = 0.008 ) and in respiratory rate ( fR ) from 21.4 + /- 5.0 breaths/min to 24.9 + /- 4.5 breaths/min ( p = 0.03 ) . No further increases were observed in these parameters beyond st and ing when activity was progressed to walking on the spot for one minute . When supine values were compared with walking on the spot for one minute , inspiratory flow rates ( VT/TI ) increased significantly from 683 + /- 131.8 ml/sec to 985.1 + /- 162.3 ml/sec ( p = 0.001 ) with significant increases in rib cage displacement ( p = 0.001 ) and no significant increase in abdominal displacement ( p = 0.23 ) . Arterial blood gases displayed no improvements following mobilisation . Changes in VT , fR , and VE were largely due to positional changes when moving from supine to st and ing Objective : To determine whether early activity is feasible and safe in respiratory failure patients . Design : Prospect i ve cohort study . Setting : From June 1 , 2003 , through December 31 , 2003 , we assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for > 4 days admitted to our respiratory intensive care unit ( RICU ) . A majority of patients were treated in another intensive care unit ( ICU ) before RICU admission . We excluded patients who required mechanical ventilation for ≤4 days . Patients : Eight‐bed RICU at LDS Hospital . Interventions : We assessed patients for early activity as part of routine respiratory ICU care . We prospect ively recorded activity events and adverse events . We defined three activity events as sit on bed , sit in chair , and ambulate . We defined six activity‐related adverse events as fall to knees , tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , oxygen desaturation < 80 % , and extubation . Measurements and Main Results : During the study period , we conducted a total of 1,449 activity events in 103 patients . The activity events included 233 ( 16 % ) sit on bed , 454 ( 31 % ) sit in chair , and 762 ( 53 % ) ambulate . In patients with an endotracheal tube in place , there were a total of 593 activity events , of which 249 ( 42 % ) were ambulation . There were < 1 % activity‐related adverse events , including fall to the knees without injury , feeding tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , and desaturation < 80 % . No patient was extubated during activity . Conclusions : We conclude that early activity is feasible and safe in respiratory failure patients . A majority of survivors ( 69 % ) were able to ambulate > 100 feet at RICU discharge . Early activity is a c and i date therapy to prevent or treat the neuromuscular complications of critical illness Objectives : To investigate whether a daily exercise session , using a bedside cycle ergometer , is a safe and effective intervention in preventing or attenuating the decrease in functional exercise capacity , functional status , and quadriceps force that is associated with prolonged intensive care unit stay . A prolonged stay in the intensive care unit is associated with muscle dysfunction , which may contribute to an impaired functional status up to 1 yr after hospital discharge . No evidence is available concerning the effectiveness of an early exercise training intervention to prevent these detrimental complications . Design : R and omized controlled trial . Setting : Medical and surgical intensive care unit at University Hospital Gasthuisberg . Patients : Ninety critically ill patients were included as soon as their cardiorespiratory condition allowed bedside cycling exercise ( starting from day 5 ) , given they still had an expected prolonged intensive care unit stay of at least 7 more days . Interventions : Both groups received respiratory physiotherapy and a daily st and ardized passive or active motion session of upper and lower limbs . In addition , the treatment group performed a passive or active exercise training session for 20 mins/day , using a bedside ergometer . Measurements and Main Results : All outcome data are reflective for survivors . Quadriceps force and functional status were assessed at intensive care unit discharge and hospital discharge . Six-minute walking distance was measured at hospital discharge . No adverse events were identified during and immediately after the exercise training . At intensive care unit discharge , quadriceps force and functional status were not different between groups . At hospital discharge , 6-min walking distance , isometric quadriceps force , and the subjective feeling of functional well-being ( as measured with “ Physical Functioning ” item of the Short Form 36 Health Survey question naire ) were significantly higher in the treatment group ( p < .05 ) . Conclusions : Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity , self-perceived functional status , and muscle force at hospital discharge STUDY OBJECTIVES To evaluate the effects of early exercise training in patients recovering from acute respiratory failure needing mechanical ventilation ( MV ) . DESIGN Prospect i ve , r and omized , and controlled study . SETTING Three respiratory intermediate ICUs ( RIICUs ) . PATIENTS Of 228 patients admitted to an RIICU , 66 patients weaned from MV from > 48 to < 96 h were considered eligible and enrolled in the study . INTERVENTION Sixty-six patients were r and omized to either supported arm exercise training plus general physiotherapy ( gPT )  [ group 1 , 32 patients ] or to gPT alone  ( group 2 , 34 patients ) . MEASUREMENTS AND RESULTS Twenty-five patients in each group completed the protocol . Group 1 showed a greater improvement in exercise capacity , as assessed by an arm incremental test ( IT ) [ p = 0.003 ] and an endurance test ( ET ) [ p = 0.021 ] , compared to group 2 . Posttraining maximal inspiratory pressure ( MIP ) significantly improved in both groups ( p < 0.001 and p = 0.003 in groups 1 and 2 respectively ; not significant ) . IT isoworkload dyspnea improved significantly in both groups ( p = 0.005 and p = 0.009 in groups 1 and 2 , respectively ; not significant between groups ) , whereas IT isoworkload peripheral muscle fatigue ( p < 0.001 ) , ET isotime dyspnea ( p < 0.01 ) , and ET isotime muscular fatigue ( p < 0.005 ) improved significantly in group 1 but not in group 2 . IT improvers ( chi2 = 0.004 ) and ET improvers ( chi2 = 0.047 ) were more frequently observed in group 1 than in group 2 . Baseline MIP could discriminate for IT ( p = 0.013 ; odds ratio [ OR ] , 1.116 ) and ET improvers ( p = 0.022 ; OR , 1.067 ) . CONCLUSION Early upper-limb exercise training is feasible in RIICU patients recently weaned from MV and can enhance the effects of gPT . Baseline inspiratory muscle function is related to exercise capacity improvement BACKGROUND : Chair-sitting may allow for more readily activated scalene , sternocleidomastoid , and parasternal intercostal muscles , and may raise and enlarge the upper thoracic cage , thereby allowing the thoracic cage to be more easily compressed . OBJECTIVE : To evaluate the effect of chair-sitting during exercise training on respiratory muscle function in mechanically ventilated patients . METHODS : We r and omized 16 patients to a control group and 18 patients to a chair-sitting group .  The patients in the chair-sitting group were transferred by 2 intensive care unit nurses from bed to armchair and rested for at least 30 min , based on the individual patient 's tolerance . We measured heart rate , blood pressure , SpO2 , and respiratory rate . In the treatment group , before transferring the patient from bed to armchair , and 30 min after the completion of chair-sitting we measured respiratory muscle function variables , including the ratio of respiratory rate ( f ) to tidal volume ( VT ) , SpO2 , maximum inspiratory pressure ( PImax ) and maximum expiratory pressure ( PEmax ) . In the control patients we took those same measurements while the patient was in semirecumbent position , before and after treatments , for at least 6 days or until the patient was discharged from the intensive care unit or died . RESULTS : The 2 groups did not significantly differ in age , sex , or clinical outcomes . Respiratory rate , VT , f/VT , SpO2 , PImax , and PEmax were not significantly better in the chair-sitting group . The study period significantly improved respiratory rate , VT , PImax , and PEmax ( all P < .001 ) , but not f/VT . CONCLUSIONS : Six days of chair-sitting exercise training did not significantly improve respiratory muscle function in mechanically ventilated patients OBJECTIVE Patients in intensive care exhibit a high degree of loss of muscle mass . Appropriate instruments are needed to document muscle wasting in these patients . The aim of this pilot study was to describe muscle wasting in patients in the intensive care unit . DESIGN Two-fold study setting : prospect i ve longitudinal and cross-sectional single-blind . PATIENTS A total of 118 patients in the intensive care unit ( length of stay 1 - 98 days ; male : female ratio 88:30 ; age 55 + /- 17 years ) were included in a two-fold study setting . METHODS Muscle layer thickness of the M. quadriceps femoris was documented using ultrasound measurement at well-defined points . Seventeen pilot- patients were measured twice ; at baseline and after 28 days . In another group of 101 patients , muscle layer thickness was determined once after a r and om length of stay . The results of both groups were compared and correlated . RESULTS In both groups , M. quadriceps femoris thickness showed a significant negative correlation with length of stay in the intensive care unit ( p < 0.01 ) . Furthermore , muscle wasting in intensive care patients could be described using a logarithmic function . CONCLUSION Loss of muscle mass shows a negative correlation with length of stay , and seems to be higher during the first 2 - 3 weeks of immobilization/intensive care unit stay . Ultrasound is a valid and practical measurement tool for documenting muscle mass ( e.g. muscle layer thickness ) as part of the daily routine at an intensive care unit BACKGROUND : The functional status and outcomes in patients with prolonged mechanical ventilation ( PMV ) are often limited by poor endurance and pulmonary mechanics , which result from the primary diseases or prolonged time bedridden . We evaluate the impact of exercise training on pulmonary mechanics , physical functional status , and hospitalization outcomes in PMV patients . METHODS : Twenty-seven subjects with PMV in our respiratory care center ( RCC ) were divided r and omly into an exercise training group ( n = 12 ) and a control group ( n = 15 ) . The exercise program comprised 10 sessions of exercise training . The measurement of pulmonary mechanics and physical functional status ( Functional Independence Measurement and Barthel index 
    Output:
    
We found that active mobilization may improve muscle strength , functional independence , and the ability to wean from ventilation and may decrease the length of stay in the intensive care unit ( ICU ) and hospital .
Active mobilization appears to have a positive effect on physical function and hospital outcomes in mechanical ventilation patients .