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. 2023 Nov 14;13(1):112.
doi: 10.1186/s13613-023-01201-1.

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Philipp Kloss #  1 , Maximilian Lindholz #  1 , Annette Milnik  2 , Elie Azoulay  3   4 , Maurizio Cecconi  5   6 , Giuseppe Citerio  7   8 , Thomas De Corte  9   10 , Frantisek Duska  11   12 , Laura Galarza  13 , Massimiliano Greco  5   6 , Armand R J Girbes  14 , Jozef Kesecioglu  15 , Johannes Mellinghoff  16 , Marlies Ostermann  17 , Mariangela Pellegrini  18   19 , Jean-Louis Teboul  20 , Jan De Waele  9   10 , Adrian Wong  21 , Stefan J Schaller  22   23 ; ESICM UNITE COVID Investigators
Collaborators, Affiliations

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Philipp Kloss et al. Ann Intensive Care. .

Abstract

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: 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: 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: 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).

Keywords: Bed rest; COVID-19; Critical care; Early ambulation; Intensive care units; Mobilisation; Physical therapy specialty; SARS-CoV-2.

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Conflict of interest statement

SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study. GC reports research grants and personal fees as a Speakers' Bureau Member and Advisory Board Member from Integra, Neuroptics, Biogen, Idorsia and Invex Therapeutics all not related with this study. MO has received lecture fees and research funding from Baxter, Fresenius Medical and Biomerieux. JDW is supported by a Senior Clinical Investigator Grant from the Flanders Research Foundation (ref. 1881020N). JDW has consulted for Pfizer, MSD, ThermoFisher (honoraria paid to institution). All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of available data, exclusion reasons, and missing data
Fig. 2
Fig. 2
ICU Mobility Scale (IMS)—level and count in the EM group. A Illustrates the percentage distribution of the two groups receiving EM and no EM. B Shows the frequency of mobilisation levels achieved within the first 72 h after admission to the intensive care unit according to the ICU Mobility Scale. The x-axis displays the ICU Mobility Scale as an ordinal scale, and the y-axis illustrates the percentage of observations. The exact values are presented in the table below. IMS-Level: 0—Nothing (lying in bed), 1—Sitting in bed, exercises in bed, 2—Passively moved to chair (no standing), 3—Sitting over edge of bed, 4—Standing, 5—Transferring bed to chair, 6—Marching on spot (at bedside), 7—Walking with assistance of 2 or more people, 8—Walking with assistance of 1 person, 9—Walking independently with a gait aid, 10—Walking independently without a gait aid
Fig. 3
Fig. 3
Sankey diagram. Sankey diagram representing the 60-day outcomes according to the No EM and EM group
See this image and copyright information in PMC

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