Hodgson, C., Bailey, M., Bellomo, R., Berney, S., Buhr, H., Denehy, L., Gabbe, B., Harrold, M., Higgins, A., Iwashyna, T., Papworth, R., Parke, R., Patman, S., Presneill, J., Saxena, M., Skinner, E., Tipping, C., Young, P., & Webb, S. (2016). A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Critical Care Medicine, 44 (6), 1145-1152.
Objectives: The primary objective was to determine if the early goal-directed mobilization (EGDM) intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared to standard care.
Design: A pilot, randomized controlled trial
Setting: Five intensive care units (ICUs) in Australia and New Zealand
Participants: Fifty critically ill adults, mechanically ventilated for greater than 24 hours.
Intervention: Patients were randomly assigned to either EGDM (intervention) or to standard care (control). EGDM comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale (IMS) while receiving mechanical ventilation.
Measurements and Main Results: The IMS, strength, ventilation duration, ICU and hospital length of stay and total inpatient (acute and rehabilitation) stay as well as six month post-ICU discharge health related quality of life, activities of daily living, and anxiety and depression were recorded.
The mean age was 61 years and 60% were male. Time from ICU admission to randomisation was 3 days. The intervention group (N=29) received a greater level of mobilization. The highest level of activity (IMS) recorded during the ICU stay between the intervention and control groups was mean (95%CI) 7.3 (6.3 – 8.3) versus 5.9 (4.9 – 6.9), p=0.05. The proportion of patients who walked in ICU was almost doubled with EGDM (intervention N=19 (66%) versus control N= 8 (38%), p=0.05). There was no difference in total inpatient stay (days) between the intervention versus control groups (20 [15-35] versus 34 [18-43], p=0.37). There were no adverse events. There was no difference in six-month outcomes.
Conclusion / Key Practice Points: Delivery of EGDM within an RCT was feasible and safe. EGDM resulted in increased duration of active exercises and an increase in the mobility milestones achieved during the ICU stay.
early goal-directed mobilization (EGDM), pilot randomized controlled trail, ICU, Australia, New Zealand