1. Early mobilization of patients after mechanical ventilation in the intensive care unit (ICU) did not lead to an improvement in the number of days alive and out of hospital.
2. Early mobilization was associated with more adverse events than routine care.
Level of evidence assessment: 1 (Excellent)
Overview of the study: Patients with severe illness are often admitted to intensive care, many of whom develop weakness, leading to increased mortality and a prolonged recovery course. This weakness is particularly marked in mechanically ventilated patients, due to muscle wasting and comorbidities related to their serious illnesses. Early mobilization has been suggested to lessen the impact of ICU-associated weakness, albeit with limited evidence and treatment standards. The present study was a randomized controlled trial to assess the effects of early mobilization or usual care on the recovery of patients who underwent mechanical ventilation in the ICU. At 180 days, the number of days patients were alive and out of hospital was not significantly different between the two groups. Both groups also showed similar results in terms of quality of life and function. Early mobilization was associated with a higher rate of adverse events. It was noted that patients receiving usual care had a higher level of baseline mobilization than in previous cohort studies. Nevertheless, these results demonstrated that early mechanical ventilation has no impact on the number of days alive and out of hospital compared to usual care.
Click here to read the study in NEJM
In depth [randomized controlled trial]: This study was a multicenter randomized controlled trial evaluating the impact of early mobilization on patients who underwent mechanical ventilation in the ICU. Adult patients were eligible if they were to receive mechanical ventilation after randomization and were stable enough for mobilization. Exclusion criteria included bed rest orders, dependence on activities of daily living before admission, and brain or spinal cord injury. Overall, 750 adult patients were randomized 1:1 to receive either early mobilization (via minimization of sedation and daily physiotherapy) or usual care (basic mobilization provided in ICU). The primary outcome was the number of days patients were alive and discharged from hospital 180 days after randomization. The early mobilization group had significantly more mobilization time per day than the usual care group, and patients receiving early mobilization were able to get up earlier than those receiving usual care. The median number of days alive and out of hospital was 143 (interquartile range [IQR]21 to 161) in the early mobilization group and 145 days (IQR, 51 to 164) in the usual care group (absolute difference, -2.0 days; 95% confidence interval [CI], -10 to 6; p=0.62). The mortality rate was 22.5% for the early mobilization group and 19.5% for the usual care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Notably, adverse events attributable to mobilization, such as arrhythmias, altered blood pressure, and desaturation, were more common in the early mobilization group (9.2%) than in the usual care group (4 .1%) (p=0.005). Although the level of mobilization administered as part of usual care was higher than in the cohort studies, this was consistent with international guidelines and other clinical trials. These results showed that early mobilization had no impact on the number of days alive and out of hospital in mechanically ventilated patients in the ICU.
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