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

Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Aires, Buenos, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean-Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, Van Leemput, Jan, Vanhove, Philippe, Bulpa, Pierre, Ilieva, Viktoria, Katz, David, Binnie, Alexandra, Geagea, Anna, Tirapegui, Fernando, Lago, Gustavo, Graf, Jerónimo, Perez-Araos, Rodrigo, Vargas, Patricio, Martinez, Felipe, Labarca, Eduardo, Franco, Daniel Molano, Parra-Tanoux, Daniela, Yepes, David, Hammouda, Ahmed, Elmandouh, Omar, Azzam, Ahmed, Hussein, Aliae Mohamed, Galal, Islam, Awad, Ahmed K., Azab, Mohammed A., Abdalla, Maged, Assal, Hebatallah, Alfishawy, Mostafa, Ghozy, Sherief, Tharwat, Samar, Eldaly, Abdullah, Ellervee, Anneli, Reinhard, Veronika, Chrisment, Anne, Poyat, Chrystelle, Badie, Julio, Berdaguer Ferrari, Fernando, Weiss, Björn, Schellenberg, Clara, Grunow, Julius J., Lorenz, Marco, Schaller, Stefan J., Spieth, Peter, Bota, Marc, Fichtner, Falk, Fuest, Kristina, Lahmer, Tobias, Herrmann, Johannes, Meybohm, Patrick, Markou, Nikolaos, Vasileiadou, Georgia, Chrysanthopoulou, Evangelia, Papamichalis, Panagiotis, Soultati, Ioanna, Jog, Sameer, Kalvit, Kushal, Nainan Myatra, Sheila, Krupa, Ivan, Tharwat, Aisa, Nichol, Alistair, McCarthy, Aine, Mahmoodpoor, Ata, Tonetti, Tommaso, Isoni, Paolo, Spadaro, Savino, Volta, Carlo Alberto, Mirabella, Lucia, Noto, Alberto, Florio, Gaetano, Guzzardella, Amedeo, Paleari, Chiara, Baccanelli, Federica, Savi, Marzia, Antonelli, Massimo, De Pascale, Gennaro, Vaccarini, Barbara, Montrucchio, Giorgia, Sales, Gabriele, Donadello, Katia, Gottin, Leonardo, Nizzero, Marta, Polati, Enrico, De Rosa, Silvia, Sulemanji, Demet, Abusalama, Abdurraouf, Elhadi, Muhammed, Jesus, Montelongo Felipe De, Gonzalez, Daniel Rodriguez, Robles, Victor Hugo Madrigal, Canedo, Nancy, Chavez, Alejandro Esquivel, Dendane, Tarek, Grady, Bart, de Jong, Ben, van der Heiden, Eveline, Thoral, Patrick, van den Bogaard, Bas, Spronk, Peter E., Achterberg, Sefanja, Groeneveld, Melanie, So, Ralph K. L., de Wijs, Calvin, Scholten, Harm, Beishuizen, Albertus, Cornet, Alexander D., Reidinga, Auke C., Kranen, Hetty, Mensink, Roos, den Boer, Sylvia, de Groot, Marcel, Beck, Oliver, Bethlehem, Carina, van Bussel, Bas, Frenzel, Tim, de Jong, Celestine, Wilting, Rob, Mehagnoul-Schipper, Jannet, Alasia, Datonye, Kumar, Ashok, Qayyum, Ahad, Rana, Muhammad, Jayyab, Mustafa Abu, Sierra, Rosario Quispe, Hernandez, Aaron Mark, Taborda, Lúcia, Anselmo, Mónica, Ramires, Tiago, Silva, Catarina, Roriz, Carolina, Morais, Rui, Póvoa, Pedro, Patricio, Patricia, Pinto, André, Santos, Maria Lurdes, Costa, Vasco, Cunha, Pedro, Gonçalves, Celina, Nunes, Sandra, Camões, João, Adrião, Diana, Oliveira, Ana, Omrani, Ali, Maslamani, Muna Al, elbuzidi, Abdurrahmaan Suei, qudah, Bara Mahmoud Al, Akkari, Abdel Rauof, Alkhatteb, Mohamed, Baiou, Anas, Husain, Ahmed, Alwraidat, Mohamed, Saif, Ibrahim Abdulsalam, Bakdach, Dana, Ahmed, Amna, Aleef, Mohamed, Bintaher, Awadh, Petrisor, Cristina, Popov, Evgeniy, Popova, Ksenia, Dementienko, Mariia, Teplykh, Boris, Pyregov, Alexey, Davydova, Liubov, Vladislav, Belskii, Neporada, Elena, Zverev, Ivan, Meshchaninova, Svetlana, Sokolov, Dmitry, Gavrilova, Elena, Shlyk, Irina, Poliakov, Igor, Vlasova, Marina, Aljuhani, Ohoud, Alkhalaf, Amina, Humaid, Felwa Bin, Arabi, Yaseen, Kuhail, Ahmed, Elrabi, Omar, Ghannam, Madihah E., Kansal, Amit, Ho, Vui Kian, Ng, Jensen, García, Raquel Rodrígez, Fraga, Xiana Taboada, del Pilar García-Bonillo, Mª, Padilla-Serrano, Antonio, Cuadrado, Marta Martin, Ferrando, Carlos, Catalan-Monzon, Ignacio, Frutos-Vivar, Fernando, Jimenez, Jorge, Rodríguez-Solis, Carmen, Franquesa-Gonzalez, Enric, Acosta, Guillermo Pérez, Cabrera, Luciano Santana, Parra, Juan Pablo Aviles, Gonzalez, Francisco Muñoyerro, del Carmen Conesa, Maria Lorente, Varela, Ignacio Yago Martinez, Pravia, Orville Victoriano Baez, Delgado, Maria Cruz Martin, de Cabo, Carlos Munoz, Ioan, Ana-Maria, Perez-Calvo, Cesar, Santos, Arnoldo, Abad-Motos, Ane, Ripolles-Melchor, Javier, Martin, Belén Civantos, Teruel, Santiago Yus, Lucas, Juan Higuera, Ortiz, Aaron Blandino, de Pablo Sánchez, Raúl, Barrueco-Francioni, Jesús Emilio, Espina, Lorena Forcelledo, Bonell-Goytisolo, José M., Salaverria, Iñigo, Mir, Antonia Socias, Rodriguez-Ruiz, Emilio, Valverde, Virginia Hidalgo, Cubero, Patricia Jimeno, Linde, Francisca Arbol, Leganes, Nieves Cruza, Romeu, Juan Maria, Concha, Pablo, Berezo-Garcia, José Angel, Fraile, Virginia, Cuenca-Rubio, Cristina, Pérez-Torres, David, Serrano, Ainhoa, Valero, Clara Martínez, Suner, Andrea Ortiz, Larrañaga, Leire, Legaristi, Noemi, Ferrigno, Gerardo, Khlafalla, Safa, Bihariesingh-Sanchit, Rosita, Zoerner, Frank, Grip, Jonathan, Kilsand, Kristina, Mårtensson, Johan, Österlind, Jonas, von Seth, Magnus, Berkius, Johan, Ceruti, Samuele, Glotta, Andrea, Izdes, Seval, Turan, Işıl Özkoçak, Cosar, Ahmet, Halacli, Burcin, Dereli, Necla, Yilmaz, Mehmet, Akbas, Türkay, Elay, Gülseren, Eyüpolu, Selin, Bílír, Yelíz, Saraçolu, Kemal Tolga, Kaya, Ebru, Sahin, Ayca Sultan, Ekren, Pervin Korkmaz, Mengi, Tuçe, Suner, Kezban Ozmen, Tomak, Yakup, Eroglu, Ahmet, Alsabbah, Asad, Hanlon, Katie, Gervin, Kevin, McMahon, Sean, Hagan, Samantha, Higenbottam, Caroline V., Mullhi, Randeep, Poulton, Lottie, Torlinski, Tomasz, Gareth, Allen, Truman, Nick, Vijayakumar, Gopal, Hall, Chris, Jubb, Alasdair, Cagova, Lenka, Jones, Nicola, Graham, Sam, Robin, Nicole, Cowton, Amanda, Donnelly, Adrian, Singatullina, Natalia, Kent, Melanie, Boulanger, Carole, Campbell, Zoë, Potter, Elizabeth, Duric, Natalie, Szakmany, Tamas ORCID: https://orcid.org/0000-0003-3632-8844, Kviatkovske, Orinta, Marczin, Nandor, Ellis, Caroline, Saha, Rajnish, Sri-Chandana, Chunda, Allan, John, Mumelj, Lana, Venkatesh, Harish, Gotz, Vera Nina, Cochrane, Anthony, Ficial, Barbara, Kamble, Shruthi, Lumlertgul, Nuttha, Oddy, Christopher, Jain, Susan, Crapelli, Giulia Beatrice, Vlachou, Aikaterini, Golden, David, Garrioch, Sweyn, Henning, Jeremy, Loveleena, Gupta, Davey, Miriam, Grauslyte, Lina, Salciute-Simene, Erika, Cook, Martin, Barling, Danny, Broadhurst, Phil, Purvis, Sarah, Spivey, Michael, Shuker, Benjamin, Grecu, Irina, Harding, Daniel, Singatullina, Natalia, Dean, James T., Nielsen, Nathan D., Al-Bayati, Sama, Al-Sadawi, Mohammed, Charron, Mariane, Stubenrauch, Peter, Santanilla, Jairo, Wentowski, Catherine, Rosenberger, Dorothea, Eksarko, Polikseni and Jawa, Randeep 2023. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study. Annals of Intensive Care 13 (1) , 112. 10.1186/s13613-023-01201-1

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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).

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	SpringerOpen
ISSN:	2110-5820
Date of First Compliant Deposit:	2 January 2024
Date of Acceptance:	5 October 2023
Last Modified:	03 Jan 2024 13:02
URI:	https://orca.cardiff.ac.uk/id/eprint/165125

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