Early mobilization during mechanical ventilation reduces risk of cognitive impairment

A study published in , found that early mobilization of ventilated adults reduced the risk of cognitive impairment one year after hospital discharge by 19%. of Lancet Respiratory Medicine.

“Research results on the effects of physical activity on cognition expand our knowledge of this important relationship.” John P. Kress, M.D. The director of the medical ICU at the Medical College of Chicago told Helio.

In a single-center, parallel, randomized controlled trial, Kress et al. analyzed 198 functionally independent adults who were on a ventilator in the ICU for less than 96 hours and had at least an additional 24 hours planned. evaluated whether or not early mobilization It can reduce the incidence of cognitive impairment 1 year after hospital discharge.

Investigators randomly assigned patients 1:1 to receive early mobilization (n = 99; mean age 57.9 years; men 59%) or usual care, including physical and occupational therapy within the first 96 hours of mechanical ventilation. (n = 99) received either mean age 54.5 years; male 56%).

At both hospital discharge and one year after discharge, investigators assessed neuromuscular weakness, days discharged, functional independence, quality of life, and cognitive impairment, defined as a Montreal Cognitive Assessment score <26. Did. % of the early mobilization group and 88% of the usual care group had data and served as the primary endpoint of the study.

Median time from intubation to first treatment session was shorter in patients who underwent early ambulation (1.1 days; interquartile range) [IQR]0.8-2) People receiving usual care (4.7 days; IQR, 3.3-6.8; P. < .0001).

At the time of discharge, cognitive impairment occurred in more patients in the usual care group than in the early ambulation group (69% vs. 54%; difference = -15.2%; 95% CI, -28.6% to -1.7%; P. = .029).

Similarly, after one year, researchers found fewer patients with cognitive impairment in the early mobilization group than in the usual care group (24% vs. 43%; absolute difference = -19.2%; 95% CI, -32.1 to -6.3%; P. = .0043).

Researchers found that early mobilization reduced the risk of cognitive impairment by 19% (RR = 0.81; 95% CI, 0.68-0.96).

“Early mobilization in ICU is very difficult and requires a dedicated team,” Kress told Healio. “Time is critical because waiting a few days before starting leads to failure. This is what happened in the usual care team study, which delayed the intervention.”

Fewer patients who received early mobilization showed ICU-acquired muscle weakness after 1 year compared with those receiving usual care (0% vs. 14%; difference = -14.1%; 95 %CI, -21 to -7.3; P. = .0001).

Quality of life tests also showed that the early mobilization group had superior scores in physical factors compared with patients in the usual care group (median 52.4; IQR 45.3-56.8 vs 41.1; IQR 31.8 -49.4; P. < .0001), investigators evaluated functional independence rate (65% vs 62%; difference = 3%, 95% CI, -10.4 to 16.5%) and quality of life mental component score (median 55.9; IQR , 50.2–58.9 vs 55.2; IQR, 49.5–59.7).

Six patients who received early mobilization experienced adverse events compared to none in the usual treatment group (P. = .029). These included tachycardia in 2 patients and hypotension, tachypnea, oxygen desaturation, arterial catheter removal and rectal tube removal in 1 patient each.

“Future studies will need to determine which patients are most likely to benefit from interventions available from limited resources (i.e., having unlimited physiotherapists and occupational therapists in the ICU). not),” Kress told Healio.

This study by Kress and colleagues adds new evidence to the literature on the benefits of early mobilization. Timothy D. Girard MD, MSCI, Assistant Professor, University of Pittsburgh School of Medicine, and Pratik P. pandari pande, MD, MSCI, Professor of Anesthesiology and Surgery at Vanderbilt University Medical Center.

“These results provide increasing evidence that mobilizing as early as possible improves outcomes in ICU-treated patients when combined with light sedation, avoidance of benzodiazepines and other delirium risk factors. “Specifically, these findings support early mobilization as a patient-centered, long-term cognitive and physical outcome that many patients prioritize over survival,” Girard and Pandharipande wrote. It is the first from a randomized controlled trial linking improvement in

For more information:

John P. Kress, M.D. can be reached by [email protected].

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