Ventilation & weaning · Rehabilitation in the critically ill
Early Active Mobilization during Mechanical Ventilation in the ICU
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Increased early active mobilisation |
| Control | Usual level of mobilisation |
| Population | 741 adults undergoing mechanical ventilation in intensive care |
| Follow-up | 180 days |
| Primary endpoint | Days alive and out of hospital at 180 days |
| Result | Median days alive and out of hospital 143 (IQR 21 to 161) with early mobilisation versus 145 (IQR 51 to 164) with usual care — absolute difference -2.0 days (95% CI -10 to 6, p=0.62). Quality of life, activities of daily living, disability, cognitive and psychological function were similar. Adverse events potentially due to mobilisation occurred in 34 of 371 (9.2%) versus 15 of 370 (4.1%), p=0.005. |
| Secondary endpoints | Quality of life, activities of daily living, cognitive and psychological function, adverse events |
Among adults undergoing mechanical ventilation in the ICU, an increase in early active mobilization did not result in a significantly greater number of days that patients were alive and out of the hospital than did the usual level of mobilization in the ICU. The intervention was associated with increased adverse events.
The trial authors, in the published abstract
The largest and most uncomfortable of the ICU rehabilitation trials. Combined with Moss 2016 and Morris 2016, the picture is consistent: more physiotherapy than usual care is not better, and beyond a point it causes arrhythmias, blood pressure disturbance and desaturation.
Hodgson CL, Bailey M, Bellomo R, et al. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med 2022 Nov 10;387(19):1747-1758.