Early Active Mobilization during Mechanical Ventilation in the ICU

TEAM Study Investigators and the ANZICS Clinical Trials Group; Carol L Hodgson; Michael Bailey; Rinaldo Bellomo; Kathy Brickell; Tessa Broadley; Heidi Buhr; Belinda J Gabbe; Doug W Gould; Meg Harrold; Alisa M Higgins; Sally Hurford; Theodore J Iwashyna; Ary Serpa Neto; Alistair D Nichol; Jeffrey J Presneill; Stefan J Schaller; Janani Sivasuthan; Claire J Tipping; Steven Webb; Paul J Young

doi:10.1056/NEJMoa2209083

Early Active Mobilization during Mechanical Ventilation in the ICU

N Engl J Med. 2022 Nov 10;387(19):1747-1758. doi: 10.1056/NEJMoa2209083. Epub 2022 Oct 26.

Authors

TEAM Study Investigators and the ANZICS Clinical Trials Group; Carol L Hodgson¹, Michael Bailey¹, Rinaldo Bellomo¹, Kathy Brickell¹, Tessa Broadley¹, Heidi Buhr¹, Belinda J Gabbe¹, Doug W Gould¹, Meg Harrold¹, Alisa M Higgins¹, Sally Hurford¹, Theodore J Iwashyna¹, Ary Serpa Neto¹, Alistair D Nichol¹, Jeffrey J Presneill¹, Stefan J Schaller¹, Janani Sivasuthan¹, Claire J Tipping¹, Steven Webb¹, Paul J Young¹

Collaborators

TEAM Study Investigators and the ANZICS Clinical Trials Group:
Carol L Hodgson, Michael Bailey, Rinaldo Bellomo, Kathy Brickell, Tessa Broadley, Heidi Buhr, Belinda J Gabbe, Doug W Gould, Meg Harrold, Alisa M Higgins, Sally Hurford, Theodore Iwashyna, Ary Serpa Neto, Alistair Nichol, Jeffrey J Presneill, Stefan J Schaller, Janani Sivasuthan, Claire Tipping, Steven Webb, Paul J Young, Sue Berney, Stephanie Jameson, Ally Macdonell, Luke McDonald, Sarah Retica, Thomas Rollinson, Joleen Rose, Nima Kakho, Joseph McCaffrey, Allison Bone, Tania Elderkin, Michelle Horton, Matthew Maiden, Stephanie Pearce, Tania Salerno, Jemma Trickey, Deirdre Murphy, David Brewster, Lisa Dougherty, Natasha Lade, Steve Philpot, Vineet Sarode, Shannon Simpson, Louisa Lightfoot, Mahesh Ramanan, Roland Bartholdy, Jean Nel, Hannelie de Beer, Jacinta Weber, Michelle Paton, Joanna Caruana, Nina Moorrees, Phoebe Naughton, Maria Shenouda, Jonathan Barrett, Gabrielle Hanlon, Rachel Fielding, Lauren Thomas, Gail Brinkerhoff, Eduardo Martinez, Amber-Louise Poulter, Sally Rose, Gaby van Balen, Ianthe Boden, Matthew Brain, Lucy Dennis, Jane Lockstone, Sarah Mineall, I Anne Leditschke, Mackenzie Finnis, Katherine Jongebloed, Jennifer Murphy, Felicity Prebble, Donna Deans, Shihoko Fukumori, Lauren McInnes, Brendan Murfin, Jackson Wood, Alicia Agli, Robin Dyball, Danielle Ferguson, Melissa McKinnon, Marc Nickels, Morag Shealy, Maree Duroux, Sharne Neill, Louise Hodges, Megan Ratcliffe, Helen Miles, Kirsty Watson, David Hamilton, Josephine Reoch, Travis Auty, Benjamin Reddi, Stephanie O'Connor, Simone Dafoe, Kathleen Glasby, Justine Rivett, Nerissa Brown, Rocky Callisto, Anna Threadgold, Celia Bradford, Angela Ashelford, Frances Bass, Leisl Davis, Anthony Delaney, Simon Finfer, Naomi Hammond, Roger Harris, Anne O'Connor, Naomi Pallas, Julia Pilowsky, Raymond Raper, Wade Stedman, Amanda Sukkar, Miyuki Tokumitsu, Elizabeth Yarad, Julian Sunario, Emily Bilish, Brittany Fergusson, Sharon Waterson, Sheldon Wulff, Nazmeen Reddy, Maryam Alborzi, Jennifer Coles, David Gattas, Wendy Chaseling, Jennene Miller, Deborah Inskip, Manoj Saxena, Eva Zveglic, Laura Sparkes, Gemma Pound, Sophie Heywood, John Santamaria, Anna Shukla, Kate McCleary, Kye Grant, David Gutierrez, Scott Bradley, Jasmin Board, Terry Chan, Jamie Cooper, Tahnee Hellings, Caitlin Le Maitre, Emma Martin, Phoebe McCracken, Kathleen Nelson, Alana Rix, Rebecca Robinson, Ben Tarrant, Shirley Vallance, Jasmn Whillas, Meredith Young, Matthew Linnane, Lawrence Caruana, Paul McCormack, Oystein Tronstad, Lisa Beach, Oshara De Silva, Caitlin Devanny, Lyndsey Hoogenhout, Jane Larkin, Jenni Medland, Jeffrey Presneill, Adam Visser, Courtney Campbell, Judy Smith, Corey Pendlebury, Georgia Staal, Kimberley Haines, Samantha Angiolella, Sam Bates, Sarah Burleigh, Kate Emery, Craig French, Elizabeth Hibbert, Jenna Lang, Melanie Paykel, Elizabeth Skinner, Monica Voong, Martin Sterba, Alan Davey-Quinn, Wenli Geng, Veerendra Jagarlamudi, Nigel Thackeray, Shay McGuinness, Farisha Ali, Chelsea Bartels, Magdalena Butler, Keri-Anne Cowdrey, Eileen Gilder, Laura Hughes, Su-Zahn Koorts, Ellie McMahon, Marianne Moore, Karina O'Connor, Rachael Parke, Melissa Robertson, Samantha Ryan, Emma Sammon, Pauline Tang, Colin McArthur, Yan Chen, Lynette Newby, Catherine Simmonds, Troy Browne, David Allen, Owen Callender, Jonathan Chen, Clive Dominy, Susanne Farrell, Jennifer Goodson, Vicki Higson, James Houghton, David Jackson, Owen Keet, Lynette McGaughran, Robert Martynoga, Renesh Nair, Annette Forrest, Amelia Butler, Sarah Rogers, Livia Schischka, Kara Trask, Maree Zimmerman, Michelle Tonks, Paul Young, April Aguilar, Nina Beehre, Kirsha Delaney, Deborah Hendry, Anna Hunt, Harriet Judd, Charlotte Latimer-Bell, Cassie Lawrence, Eden Lesona, Agnes McKay Vucago, Alex Millington, Lean Navarra, Shaanti Olatunji, Yve Robertson, Daniel Seller, Hannah Smellie, Rhoze Sol Cruz, Raulle Sol Cruz, Chelsea Young, Daniel Collins, Michelle Smyth, Jane Dickson, Jenny Caffrey, Maire Gilmartin, Leanne Hayes, Enya Mulcahy, Michael O Dwyer, Arabella Fahy, Maria Baily-Scanlan, Sabina Mason, Elaine Joyce, Laura Hammond, John Laffey, Siobhan Casey, Claire Kelly, Merve Kernan, Bairbre McNicholas, Deirdre O'Dowd, Esther O'Flaherty, Julius Grunow, Clara Schellenberg, Leonie Hartmann, Annett Reishauer, Manfred Blobner, Kristina Fuest, Jana Schultz, Astrid Ruß, Sirak Petros, Niklas Hellwig, Frank Neubert, Christoph Schnabel, Simone Schwarz, Nadine Stegner, Kathrin Stöver, Martin Beed, Eleanor Douglas, Cecilia Peters, Lucy Ryan, George Evetts, Hannah Boynes, Lianne Chapman, Georgina Linstead, Phil Hopkins, Emma Clarey, Rebecca Davies, Maria Depante, Emily Flowers, Harriet Noble, Evita Pappa, Ceri Battle, Gemma Collins, Katie Davies, Debra Evans, Elizabeth Ford, Karen James, Sharon Jones, Luke Newey, Sharon Storton, Dumindu Karangoda, Rebecca Bays, Amy Collins, Annika Roberts, Estefania Treus Gude, Louise Koslicki, Melanie Gager, Shauna Bartley, Parminder Bhuie, Nicola Jacques, Sabi Rai, Victoria Samways, William English, Sarah Bean, Karen Burt, Tom Cornell, Alice Gibson, Michelle Hague, Waqas Khaliq, Harriet Bryce, Rosie Reece-Anthony, Vinicius Maldaner, Robert De Melo, Graziani Ferreira, Ingrid Menezes, Márcia Rocha, Liz Melgaard, Amanda Brown, Bentley Fulcher, Anne Turner, Sarah Grotheer, Alicja Nowakowska, Sima Sattari, Robert Darnell, Danny McAuley, Catherine Hough, David Harrison, Janani Sivasuthan, Elizabeth Ayre, Doug Gould, Bronwen Connolly, Kathy Brickell, Stefan J Schaller

Affiliation

¹ From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.).

PMID: 36286256
DOI: 10.1056/NEJMoa2209083

Abstract

Background: Intensive care unit (ICU)-acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability.

Methods: We randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilation to receive increased early mobilization (sedation minimization and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU). The primary outcome was the number of days that the patients were alive and out of the hospital at 180 days after randomization.

Results: The median number of days that patients were alive and out of the hospital was 143 (interquartile range, 21 to 161) in the early-mobilization group and 145 days (interquartile range, 51 to 164) in the usual-care group (absolute difference, -2.0 days; 95% confidence interval [CI], -10 to 6; P = 0.62). The mean (±SD) daily duration of active mobilization was 20.8±14.6 minutes and 8.8±9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; 95% CI, 10.4 to 13.6). A total of 77% of the patients in both groups were able to stand by a median interval of 3 days and 5 days, respectively (difference, -2 days; 95% CI, -3.4 to -0.6). By day 180, death had occurred in 22.5% of the patients in the early-mobilization group and in 19.5% of those in the usual-care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups. Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group (P = 0.005).

Conclusions: 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. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.).

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adult
Critical Care* / methods
Early Ambulation* / adverse effects
Early Ambulation* / methods
Humans
Intensive Care Units
Physical Therapy Modalities / adverse effects
Quality of Life
Respiration, Artificial*

Associated data

ClinicalTrials.gov/NCT03133377

Abstract

Publication types

MeSH terms

Associated data

Grants and funding