Early mobilization in the ICU has been recommended by consensus based on its strong rational basis (as a large proportion of critically ill patients develop weakness) and its apparent safety, with limited low-quality evidence supporting its benefits. In the TEAM trial conducted by the ANZICS group, 750 ICU patients in 49 hospitals in 6 countries were randomized to either early mobilization or usual care (which usually included in-bed physical therapy). Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). More patients (9% vs 4%) had adverse events in the early mobilization group, including 7 serious events in the early-mobilization group (mostly arrhythmias and one stroke) vs 1 in the usual care group. Although a negative trial, it did not disprove any benefit of early mobilization — as even patients in the usual-care group received physiotherapy on >80% of their ICU days, far more than in most U.S. ICUs.
Issue #2: The Latest in Critical Care, 5/22/23
Issue #2: The Latest in Critical Care…
Issue #2: The Latest in Critical Care, 5/22/23
Early mobilization in the ICU has been recommended by consensus based on its strong rational basis (as a large proportion of critically ill patients develop weakness) and its apparent safety, with limited low-quality evidence supporting its benefits. In the TEAM trial conducted by the ANZICS group, 750 ICU patients in 49 hospitals in 6 countries were randomized to either early mobilization or usual care (which usually included in-bed physical therapy). Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). More patients (9% vs 4%) had adverse events in the early mobilization group, including 7 serious events in the early-mobilization group (mostly arrhythmias and one stroke) vs 1 in the usual care group. Although a negative trial, it did not disprove any benefit of early mobilization — as even patients in the usual-care group received physiotherapy on >80% of their ICU days, far more than in most U.S. ICUs.