Effects of the High-Intensity Early Mobilization on Long-Term Functional Status of Patients with Mechanical Ventilation in the Intensive Care Unit

Overview

Journal Crit Care Res Pract

Publisher Wiley

Specialty Critical Care

Date 2024 Apr 1

PMID 38560481

Authors

Chuanlin Zhang

Xueqin Wang

Jie Mi

Zeju Zhang

Xinyi Luo

Ruiying Gan

Shaoyu Mu

Affiliations

Soon will be listed here.

Abstract

Objective: Intensive care unit (ICU)-acquired weakness often occurs in patients with invasive mechanical ventilation (IMV). Early active mobility may reduce ICU-acquired weakness, improve functional status, and reduce disability. The aim of this study was to investigate whether high-intensity early mobility improves post-ICU discharge functional status of IMV patients.

Methods: 132 adult patients in the ICU who were undergoing IMV were randomly assigned into two groups with a ratio of 1 : 1, with one group received high-intensity early mobility (intervention group, IG), while the other group received conventional treatment (control group, CG). The functional status (Barthel Index (BI)), capacity of mobility (Perme score and ICU Mobility Scale (IMS)), muscle strength (Medical Research Council sum scores (MRC-SS)), mortality, complication, length of ICU stay, and duration of IMV were evaluated at ICU discharge or after 3-month of ICU discharge.

Results: The patient's functional status was improved (BI scores 90.6 ± 18.0 in IG vs. 77.7 ± 27.9 in CG; =0.005), and capacity of mobility was increased (Perme score 17.6 ± 7.1 in IG vs. 12.2 ± 8.5 in CG, < 0.001; IMS 4.7 ± 2.6 in IG vs. 3.0 ± 2.6 in CG, < 0.001). The IG had a higher muscle strength and lower incidence of ICU-acquired weakness (ICUAW) than that in the CG. The incidence of mortality and delirium was also lower than CG at ICU discharge. However, there were no differences in terms of length of ICU stay, duration of IMV, ventilator-associated pneumonia, and venous thrombosis.

Conclusions: High-intensity early mobility improved the patient's functional status and increased capacity of mobility with IMV. The benefits to functional status remained after 3 month of ICU discharge. Other benefits included higher muscle strength, lower incidence of ICUAW, mortality, and delirium in IG.

References

Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C . Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678):1874-82. PMC: 9906655. DOI: 10.1016/S0140-6736(09)60658-9. View

Mirzakhani H, Williams J, Mello J, Joseph S, Meyer M, Waak K . Muscle weakness predicts pharyngeal dysfunction and symptomatic aspiration in long-term ventilated patients. Anesthesiology. 2013; 119(2):389-97. DOI: 10.1097/ALN.0b013e31829373fe. View

Stripari Schujmann D, Gomes T, Lunardi A, Zoccoler Lamano M, Fragoso A, Pimentel M . Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial. Crit Care Med. 2020; 48(4):491-497. DOI: 10.1097/CCM.0000000000004181. View

Nydahl P, Jeitziner M, Vater V, Sivarajah S, Howroyd F, McWilliams D . Early mobilisation for prevention and treatment of delirium in critically ill patients: Systematic review and meta-analysis. Intensive Crit Care Nurs. 2023; 74:103334. DOI: 10.1016/j.iccn.2022.103334. View

Reis N, Figueiredo F, Biscaro R, Lunardelli E, Maurici R . Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge. Am J Crit Care. 2022; 31(1):65-72. DOI: 10.4037/ajcc2022732. View

Lang J, Paykel M, Haines K, Hodgson C . Clinical Practice Guidelines for Early Mobilization in the ICU: A Systematic Review. Crit Care Med. 2020; 48(11):e1121-e1128. DOI: 10.1097/CCM.0000000000004574. View

Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan M, Yebyo H . Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care. 2021; 25(1):16. PMC: 7789482. DOI: 10.1186/s13054-020-03446-9. View

Stevens R, Dowdy D, Michaels R, Mendez-Tellez P, Pronovost P, Needham D . Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007; 33(11):1876-91. DOI: 10.1007/s00134-007-0772-2. View

Van Aerde N, Meersseman P, Debaveye Y, Wilmer A, Gunst J, Casaer M . Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study. Intensive Care Med. 2020; 46(6):1184-1193. DOI: 10.1007/s00134-020-05927-5. View

10.

Faul F, Erdfelder E, Buchner A, Lang A . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4):1149-60. DOI: 10.3758/BRM.41.4.1149. View

11.

Zayed Y, Kheiri B, Barbarawi M, Chahine A, Rashdan L, Chintalapati S . Effects of neuromuscular electrical stimulation in critically ill patients: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2019; 33(2):203-210. DOI: 10.1016/j.aucc.2019.04.003. View

12.

Timenetsky K, Serpa Neto A, Assuncao M, Taniguchi L, Eid R, Correa T . Mobilization practices in the ICU: A nationwide 1-day point- prevalence study in Brazil. PLoS One. 2020; 15(4):e0230971. PMC: 7117707. DOI: 10.1371/journal.pone.0230971. View

13.

Ding N, Zhang Z, Zhang C, Yao L, Yang L, Jiang B . What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis. PLoS One. 2019; 14(10):e0223151. PMC: 6779259. DOI: 10.1371/journal.pone.0223151. View

14.

Stripari Schujmann D, Lunardi A, Fu C . Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial. Trials. 2018; 19(1):274. PMC: 5946399. DOI: 10.1186/s13063-018-2641-4. View

15.

Scheffenbichler F, Teja B, Wongtangman K, Mazwi N, Waak K, Schaller S . Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study. Crit Care Med. 2021; 49(3):e247-e257. PMC: 7902391. DOI: 10.1097/CCM.0000000000004808. View

16.

Watanabe S, Morita Y, Suzuki S, Kochi K, Ohno M, Liu K . Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients. Prog Rehabil Med. 2022; 6:20210054. PMC: 8710675. DOI: 10.2490/prm.20210054. View

17.

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

18.

Liu H, Tian Y, Jiang B, Song Y, Du A, Ji S . Early mobilisation practice in intensive care units: A large-scale cross-sectional survey in China. Nurs Crit Care. 2023; 28(4):510-518. DOI: 10.1111/nicc.12896. View

19.

Sulter G, Steen C, De Keyser J . Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999; 30(8):1538-41. DOI: 10.1161/01.str.30.8.1538. View

20.

Jarman A, Chapman K, Vollam S, Stiger R, Williams M, Gustafson O . Investigating the impact of physical activity interventions on delirium outcomes in intensive care unit patients: A systematic review and meta-analysis. J Intensive Care Soc. 2023; 24(1):85-95. PMC: 9975810. DOI: 10.1177/17511437221103689. View