The optimal dose of mobilisation therapy in the ICU: a prospective cohort study.

Autor: Lorenz M; Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany.; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Fuest K; Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany., Ulm B; Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany.; University Hospital Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ulm, Germany., Grunow JJ; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Warner L; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Bald A; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Arsene V; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Verfuß M; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Daum N; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany., Blobner M; Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany.; University Hospital Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ulm, Germany., Schaller SJ; Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany. s.schaller@tum.de.; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany. s.schaller@tum.de.
Jazyk: angličtina
Zdroj: Journal of intensive care [J Intensive Care] 2023 Nov 20; Vol. 11 (1), pp. 56. Date of Electronic Publication: 2023 Nov 20.
DOI: 10.1186/s40560-023-00703-1
Abstrakt: Background: This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge.
Methods: Prospective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated.
Results: Daily mobilisation ≥ 40 min was identified as an independent predictor of an improved functional status upon ICU discharge. This effect on the primary outcome measure, change of Mobility-Barthel until ICU discharge, was observed in three different models for baseline patient characteristics (average treatment effect (ATE), all three models p < 0.001). When mobilisation parameters like level of mobilisation, were included in the analysis, the average treatment effect disappeared [ATE 1.0 (95% CI - 0.4 to 2.4), p = 0.16].
Conclusions: A mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels.
Trial Registration: Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018-retrospectively registered, https://classic.
Clinicaltrials: gov/ct2/show/NCT03666286 .
(© 2023. The Author(s).)
Databáze: MEDLINE
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