Early mobilization among patients receiving mechanical ventilation in the ICU has been proposed to lessen the impact of ICU-associated weakness, as well as increased the number of days that patients were alive out of the hospital, according to Carol L. Hodgson, PhD.
To investigate this further, Dr. Hodgson and colleagues conducted a randomized controlled trial (RCT) to compare the effects of early mobilization or usual care on the recovery of patients who underwent mechanical ventilation in the ICU. The study findings were published in The New England Journal of Medicine.
Adult patients were randomized 1:1 to receive either usual care (baseline mobilization provided in the ICU) or early mobilization (via sedation minimization and daily physiotherapy).
“The TEAM trial was an international, multicenter RCT that compared two doses of early active mobilization in 750 adults undergoing invasive mechanical ventilation in the ICU,” Dr. Hodgson explains “The intervention group received a higher dose of mobilization than [those in] usual care (20.8±14.6 vs 8.8±9.0 minutes), which was delivered 1 to 2 days earlier than [in] usual care.”
Patients in the Early Mobilization Group Were Able to Stand Earlier
Patients were eligible to participate in the study if they were expected to undergo mechanical ventilation following randomization and were healthy enough to mobilization. Patients excluded included those assigned mandatory bed rest, those with brain or spinal cord injury, or those who relied on others for assistance with activities of daily living prior to admission.
The number of days patients were alive and out of the hospital at 180 days following randomization was the primary outcome. The early mobilization group had considerably more mobilization time daily than the usual care group, according to the study team. Addition[1]ally, patients in the early mobilization group were able to stand earlier than those in the usual care group.
The median number of days alive and out of the hospital was 143 (interquartile range [IQR], 21-161) in the early mobilization group and 145 days (IQR, 51-164) in the usual care group (absolute difference, -2.0 days; 95% CI, -10 to 6). For the early mobilization group, the mortality rate was 22.5%; for the usual care group, it was 19.5% (OR, 1.15; 95% CI, 0.81-1.65).
Early Mobilization Linked With Higher Incidence of Adverse Events
However, at 180 days, Dr. Hodgson and colleagues observed that the number of days patients were alive and out of the hospital was not considerably different between the two groups. Both groups also demonstrated similar outcomes in function and QOL.
Early mobilization was linked with a higher incidence of adverse events commonly associated with mobilization, such as blood pressure alteration, arrhythmias, and desaturation, which occurred more often in the early mobilization group (9.2%) compared with the usual care group (4.1%; P=0.005).
“Early active mobilization (intervention) did not affect the number of days alive and out of the hospital at 6 months compared with the usual level of in-ICU mobilization, but was associated with increased adverse events,” Dr. Hodgson says.
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