Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study.
Bed rest
COVID-19
Critical care
Early ambulation
Intensive care units
Mobilisation
Physical therapy specialty
SARS-CoV-2
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
14 Nov 2023
14 Nov 2023
Historique:
received:
07
05
2023
accepted:
05
10
2023
medline:
14
11
2023
pubmed:
14
11
2023
entrez:
14
11
2023
Statut:
epublish
Résumé
Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
Sections du résumé
BACKGROUND
BACKGROUND
Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave.
METHODS
METHODS
This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs.
RESULTS
RESULTS
Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates.
CONCLUSIONS
CONCLUSIONS
Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
Identifiants
pubmed: 37962748
doi: 10.1186/s13613-023-01201-1
pii: 10.1186/s13613-023-01201-1
pmc: PMC10645963
doi:
Banques de données
ClinicalTrials.gov
['NCT04836065']
Types de publication
Journal Article
Langues
eng
Pagination
112Investigateurs
Buenos Aires
(B)
Alicia Gira
(A)
Philipp Eller
(P)
Tarikul Hamid
(T)
Injamam Ull Haque
(IU)
Wim De Buyser
(W)
Antonella Cudia
(A)
Daniel De Backer
(D)
Pierre Foulon
(P)
Vincent Collin
(V)
Jolien Van Hecke
(J)
Elisabeth De Waele
(E)
Claire Van Malderen
(C)
Jean-Baptiste Mesland
(JB)
Patrick Biston
(P)
Michael Piagnerelli
(M)
Lionel Haentjens
(L)
Nicolas De Schryver
(N)
Jan Van Leemput
(J)
Philippe Vanhove
(P)
Pierre Bulpa
(P)
Viktoria Ilieva
(V)
David Katz
(D)
Alexandra Binnie
(A)
Anna Geagea
(A)
Fernando Tirapegui
(F)
Gustavo Lago
(G)
Jerónimo Graf
(J)
Rodrigo Perez-Araos
(R)
Patricio Vargas
(P)
Felipe Martinez
(F)
Eduardo Labarca
(E)
Daniel Molano Franco
(DM)
Daniela Parra-Tanoux
(D)
David Yepes
(D)
Ahmed Hammouda
(A)
Omar Elmandouh
(O)
Ahmed Azzam
(A)
Aliae Mohamed Hussein
(AM)
Islam Galal
(I)
Ahmed K Awad
(AK)
Mohammed A Azab
(MA)
Maged Abdalla
(M)
Hebatallah Assal
(H)
Mostafa Alfishawy
(M)
Sherief Ghozy
(S)
Samar Tharwat
(S)
Abdullah Eldaly
(A)
Anneli Ellervee
(A)
Veronika Reinhard
(V)
Anne Chrisment
(A)
Chrystelle Poyat
(C)
Julio Badie
(J)
Fernando Berdaguer Ferrari
(F)
Björn Weiss
(B)
Clara Schellenberg
(C)
Julius J Grunow
(JJ)
Marco Lorenz
(M)
Stefan J Schaller
(SJ)
Peter Spieth
(P)
Marc Bota
(M)
Falk Fichtner
(F)
Kristina Fuest
(K)
Tobias Lahmer
(T)
Johannes Herrmann
(J)
Patrick Meybohm
(P)
Nikolaos Markou
(N)
Georgia Vasileiadou
(G)
Evangelia Chrysanthopoulou
(E)
Panagiotis Papamichalis
(P)
Ioanna Soultati
(I)
Sameer Jog
(S)
Kushal Kalvit
(K)
Sheila Nainan Myatra
(S)
Ivan Krupa
(I)
Aisa Tharwat
(A)
Alistair Nichol
(A)
Aine McCarthy
(A)
Ata Mahmoodpoor
(A)
Tommaso Tonetti
(T)
Paolo Isoni
(P)
Savino Spadaro
(S)
Carlo Alberto Volta
(CA)
Lucia Mirabella
(L)
Alberto Noto
(A)
Gaetano Florio
(G)
Amedeo Guzzardella
(A)
Chiara Paleari
(C)
Federica Baccanelli
(F)
Marzia Savi
(M)
Massimo Antonelli
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Gennaro De Pascale
(G)
Barbara Vaccarini
(B)
Giorgia Montrucchio
(G)
Gabriele Sales
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Katia Donadello
(K)
Leonardo Gottin
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Marta Nizzero
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Enrico Polati
(E)
Silvia De Rosa
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Demet Sulemanji
(D)
Abdurraouf Abusalama
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Muhammed Elhadi
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Montelongo Felipe De Jesus
(MF)
Daniel Rodriguez Gonzalez
(DR)
Victor Hugo Madrigal Robles
(VHM)
Nancy Canedo
(N)
Alejandro Esquivel Chavez
(AE)
Tarek Dendane
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Bart Grady
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Ben de Jong
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Eveline van der Heiden
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Patrick Thoral
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Bas van den Bogaard
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Peter E Spronk
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Sefanja Achterberg
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Aaron Mark Hernandez
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(L)
Mónica Anselmo
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Tiago Ramires
(T)
Catarina Silva
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(P)
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André Pinto
(A)
Maria Lurdes Santos
(ML)
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(V)
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Celina Gonçalves
(C)
Sandra Nunes
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João Camões
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Diana Adrião
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Ana Oliveira
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Ali Omrani
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Muna Al Maslamani
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Abdurrahmaan Suei Elbuzidi
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Abdel Rauof Akkari
(AR)
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(IA)
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Jensen Ng
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(A)
Asad Alsabbah
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(CV)
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Lottie Poulton
(L)
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Gopal Vijayakumar
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Lenka Cagova
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Chunda Sri-Chandana
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Anthony Cochrane
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Sweyn Garrioch
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(J)
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(C)
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(P)
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(R)
Informations de copyright
© 2023. The Author(s).
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