Early mobilization in the ICU
Trial question
What is the effect of early mobilization in ICU patients after mechanical ventilation?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
43.0% female
57.0% male
N = 198
198 patients (85 female, 113 male).
Inclusion criteria: adult patients who were functionally independent and mechanically ventilated.
Key exclusion criteria: rapidly changing neurological conditions; cardiac arrest as cause of respiratory failure; elevated ICP; pregnancy; terminal condition; traumatic brain injury.
Interventions
N=99 early mobilization (early physical therapy occupational therapy delivered by a team consisting of physical and occupational therapists).
N=99 standard care (physical therapy occupational therapy delivered as ordered by the primary ICU team).
Primary outcome
Rate of cognitive impairment 1 year after hospital discharge
24%
43%
43.0 %
32.3 %
21.5 %
10.8 %
0.0 %
Early
mobilization
Standard
care
Significant
decrease ▼
NNT = 5
Significant decrease in the rate of cognitive impairment 1 year after hospital discharge (24% vs. 43%; ARD -19.2, 95% CI -32.1 to -6.3).
Secondary outcomes
Significant increase in Montreal Cognitive Assessment score at 1 year (26 points vs. 23 points; AD 3 points, 95% CI 1 to 4).
Significant decrease in cognitive impairment at hospital discharge (54% vs. 69%; ARD -15.2, 95% CI -28.6 to -1.7).
Significant decrease in ICU-acquired weakness at 1 year (0% vs. 14%; ARD -14.1, 95% CI -21 to -7.3).
Safety outcomes
Significant difference in adverse events (6% vs. 0%).
Conclusion
In adult patients who were functionally independent and mechanically ventilated, early mobilization was superior to standard care with respect to the rate of cognitive impairment 1 year after hospital discharge.
Reference
Bhakti K Patel, Krysta S Wolfe, Shruti B Patel et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med. 2023 Jun;11(6):563-572.
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