No benefit and potential harm with increasing early mobilization in mechanically ventilated patients

Référence

The TEAM Study Investigators and the ANZICS Clinical Trials Group, Hodgson CL, Bailey M, et al. Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 2022;387(19):1747-1758.

Sommaire

In this multicenter trial, investigators randomized adult patients using mechanical ventilation in the intensive care unit (ICU) to receive early mobilization (n = 372) or usual care (n = 378). In the intervention group, sedation was minimized and daily physical therapy was provided to achieve the highest level of mobilization deemed safe for individual patients. The control group received the usual level of mobilization provided in each ICU. The intervention and control groups were similar at baseline: an average age of 60 years and approximately 35% were women. The mean daily duration of mobilization per patient was 20.8 minutes in the early mobilization groups and 8.8 minutes in the usual care group. At day 180, there was no significant difference detected in the number of days alive and out of the hospital. The 2 groups were also similar in the number of ventilator-free days at 28 days and the number of deaths at 180 days. Adverse events — most often oxygen desaturation, altered blood pressure, and cardiac arrhythmia — were more common in the early mobilization group (9.2% vs 4.1%; P = .005).