Inclusion criteria | Exclusion criteria |
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1. Age ≥ 18 years 2. Patient admitted to the ICU within the past 48 h 3. Personal consultee provides declaration of agreement for patient enrolment, retrospective patient consent 4. Non-invasive ventilation (CPAP) or invasive mechanical ventilation 5. At least two other organ failures as defined by scoring ≥ 1 points on two of the SOFA score domains 6. Likely to remain in the ICU for at least 4 days | 1. Profound cardiovascular instability—infused vasopressors ≥ 0.5 μg/kg/min of norepinephrine; or in opinion of senior attending doctor 2. Profound coagulopathy (prothrombin time > 2.5 times normal, APTT > 2 times normal or platelet count ≤ 50), bleeding diathesis or on intravenous heparin infusion APTR ≥ 2 3. Neuromuscular condition—any previous or concurrent neurological condition or muscle disease 4. History of peripheral arterial vascular disease—any previous surgery or interventional procedure for peripheral arterial insufficiency; or any reason to clinically suspect arterial insufficiency of the leg, such as collateral history of claudication or examination findings of absent peripheral pulses 5. Prior amputation of a lower limb 6. Thigh circumference > 77 cm (technical limitations) 7. Unlikely to survive the ICU 8. Disseminated malignancy 9. Pregnancy 10. Previous, or current, deep vein thrombosis and/or pulmonary embolism 11. Positioned prone 12. Contraindication to pharmacological venous thromboembolism prophylaxis 13. Pre-existing significant cognitive impairment 14. Enrolled in a conflicting interventional trial 15. Lack of ability to communicate in verbal and written English 16. Patient hospitalised > 48 h prior to ICU admission 17. Frail skin, skin condition or soft tissue infection or other reason that prevents experimental use of upper limb |