Impact of High-Dose Early Mobilization on Outcomes for Patients with Diabetes: A Secondary Analysis of the TEAM Trial.

Autor: Serpa Neto A; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Data Analytics Research & Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia.; Department of Critical Care and.; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil., Bailey M; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and., Seller D; Medical Research Institute of New Zealand, Wellington, New Zealand.; Physiotherapy Team, Te Whatu Ora - Capital, Coast, Wellington, New Zealand.; School of Physiotherapy, University of Otago, Wellington, New Zealand., Agli A; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia., Bellomo R; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Data Analytics Research & Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia.; Department of Critical Care and.; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia., Brickell K; University College Dublin, Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland., Broadley T; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and., Buhr H; Intensive Care Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia., Gabbe BJ; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Gould DW; Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, United Kingdom., Harrold M; Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia.; Department of Physiotherapy, Royal Perth Hospital, Perth, Western Australia, Australia., Higgins AM; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Critical Care Division, The George Institute for Global Health, Sydney, New South Wales, Australia., Hurford S; Medical Research Institute of New Zealand, Wellington, New Zealand., Iwashyna TJ; Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan.; Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland., Nichol AD; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Department of Intensive Care and.; University College Dublin, Clinical Research Centre at St. Vincent's University Hospital, Dublin, Ireland., Presneill JJ; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Department of Critical Care and.; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia., Schaller SJ; Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Sivasuthan J; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and., Tipping CJ; Intensive Care Unit and Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia., Poole A; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Parke R; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.; School of Nursing, University of Auckland, Auckland, New Zealand; and., Bradley S; Intensive Care Unit and Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia., Webb S; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Intensive Care Unit, St. John of God Hospital Subiaco, Perth, Western Australia, Australia., Zoungas S; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Young PJ; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Department of Critical Care and.; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.; Medical Research Institute of New Zealand, Wellington, New Zealand., Hodgson CL; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and.; Critical Care Division, The George Institute for Global Health, Sydney, New South Wales, Australia.; Department of Critical Care and.; Intensive Care Unit and Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2024 Sep 15; Vol. 210 (6), pp. 779-787.
DOI: 10.1164/rccm.202312-2289OC
Abstrakt: Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status. Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0-153] vs. 147 [82-164]; P  = 0.013) and higher 180-day mortality (30% vs. 18%; P  = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0-144.5) in patients with diabetes and 146.5 (95.8-163.0) in patients without diabetes ( P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67-7.61; P value for interaction = 0.001). Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality.
Databáze: MEDLINE