Early Active Mobilization During Mechanical Ventilation in the ICU
Published on: April 24, 2023
The results of a new study show that for adults receiving mechanical ventilation in the intensive care unit (ICU), increasing early active mobilization did not lead to a substantially higher number of days that patients were alive and out of the hospital compared with the standard level of mobilization when in the ICU. A total of 750 ICU patients who were undergoing invasive mechanical ventilation were randomized to receive increased early mobilization - consisting of sedation minimization and daily physiotherapy - or usual care, involving the standard level of mobilization provided in each ICU. At 180 days after randomization, patients in the early-mobilization group had a median of 143 days alive and out of the hospital — the primary outcome — compared with 145 days in the usual-care group. Seventy-seven percent of the patients in both groups could stand by a median period of 3 days and 5 days, respectively. The mortality rate by day 180 was 22.5% for patients in the early-mobilization group and 19.5% in the usual-care group. Factors such as quality of life, activities of daily living, disability, cognitive function, and psychological function were similar for survivors in both groups. A total of 9.2% of patients in the early-mobilization group experienced adverse events potentially due to mobilization — such as arrhythmias, altered blood pressure, and desaturation — versus 4.1% of the usual-care group. Serious adverse events were more common in the early-mobilization group as well, occurring in seven patients vs. one in the usual-care group.