Early active mobilization during mechanical ventilation in the ICU

Summary

Background

Weakness acquired in the intensive care unit (ICU) often develops in patients undergoing invasive mechanical ventilation. Early active mobilization can alleviate ICU-acquired weakness, increase survival, and reduce disability.

Methods

We randomly assigned 750 adult ICU patients who were undergoing invasive mechanical ventilation to receive increased early mobilization (minimization of sedation and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU) . The primary outcome was the number of days patients were alive and discharged from hospital 180 days after randomisation.

Results

The median number of days that patients were alive and out of hospital was 143 (interquartile range, 21 to 161) in the early mobilization group and 145 days (interquartile range, 51 to 164) in the usual care group (absolute difference , −2.0 days; 95% confidence interval [CI], -10 to 6; p=0.62). The mean (± SD) daily duration of active mobilization was 20.8 ± 14.6 minutes and 8.8 ± 9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; CI to 95%, 10.4 to 13.6). A total of 77% of patients in both groups were able to stand for a median interval of 3 days and 5 days, respectively (difference, -2 days; 95% CI, -3.4 to -0.6). By day 180, death had occurred in 22.5% of patients in the early mobilization group and in 19.5% of those in the usual care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in both groups. Serious adverse events were reported in 7 patients in the early mobilization group and in 1 patient in the usual care group. Adverse events potentially due to mobilization (arrhythmias, altered blood pressure and desaturation) were reported in 34 of 371 patients (9.2%) in the early mobilization group and in 15 of 370 patients (4.1%) in the usual care group. group (P = 0.005).

conclusion

In mechanically ventilated adults in the ICU, an increase in early active mobilization did not result in a significantly greater number of days patients were alive and out of hospital than the usual level of ICU mobilization. The intervention was associated with an increase in adverse events. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.)

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