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

Philipp Kloss; Maximilian Lindholz; Annette Milnik; Elie Azoulay; Maurizio Cecconi; Giuseppe Citerio; Thomas De Corte; Frantisek Duska; Laura Galarza; Massimiliano Greco; Armand R. J. Girbes; Jozef Kesecioglu; Johannes Mellinghoff; Marlies Ostermann; Mariangela Pellegrini; Jean-Louis Teboul; Jan De Waele; Adrian Wong; Stefan J. Schaller

doi:10.1186/s13613-023-01201-1

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

Philipp Kloss, Maximilian Lindholz, Annette Milnik, Elie Azoulay, Maurizio Cecconi, Giuseppe Citerio, Thomas De Corte, Frantisek Duska, Laura Galarza, Massimiliano Greco, Armand R. J. Girbes, Jozef Kesecioglu, Johannes Mellinghoff, Marlies Ostermann, Mariangela Pellegrini, Jean-Louis Teboul, Jan De Waele, Adrian Wong, Stefan J. Schaller

School of Sport and Health Sciences

Research output: Contribution to journal › Article › peer-review

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).

Original language	English
Article number	112 (2023)
Journal	Annals of Intensive Care
Volume	13
DOIs	https://doi.org/10.1186/s13613-023-01201-1
Publication status	Published - 14 Nov 2023

Bibliographical note

Funding Information:
Open Access funding enabled and organized by Projekt DEAL. This study was supported by the European Society of Intensive Care Medicine.

Funding Information:
SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study. GC reports research grants and personal fees as a Speakers' Bureau Member and Advisory Board Member from Integra, Neuroptics, Biogen, Idorsia and Invex Therapeutics all not related with this study. MO has received lecture fees and research funding from Baxter, Fresenius Medical and Biomerieux. JDW is supported by a Senior Clinical Investigator Grant from the Flanders Research Foundation (ref. 1881020N). JDW has consulted for Pfizer, MSD, ThermoFisher (honoraria paid to institution). All other authors declare no competing interests.

Publisher Copyright:
© 2023, The Author(s).

Keywords

Intensive care units
Critical care
Physical therapy specialty
Bed rest
Mobilisation
COVID-19
SARS-CoV-2
Early ambulation

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Kloss, P., Lindholz, M., Milnik, A., Azoulay, E., Cecconi, M., Citerio, G., De Corte, T., Duska, F., Galarza, L., Greco, M., Girbes, A. R. J., Kesecioglu, J., Mellinghoff, J., Ostermann, M., Pellegrini, M., Teboul, J-L., De Waele, J., Wong, A., & Schaller, S. J. (2023). Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study. Annals of Intensive Care, 13, Article 112 (2023). https://doi.org/10.1186/s13613-023-01201-1

@article{324e093382f44975a452f4cc79f62c68,

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

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).",

keywords = "Intensive care units, Critical care, Physical therapy specialty, Bed rest, Mobilisation, COVID-19, SARS-CoV-2, Early ambulation",

author = "Philipp Kloss and Maximilian Lindholz and Annette Milnik and Elie Azoulay and Maurizio Cecconi and Giuseppe Citerio and {De Corte}, Thomas and Frantisek Duska and Laura Galarza and Massimiliano Greco and Girbes, {Armand R. J.} and Jozef Kesecioglu and Johannes Mellinghoff and Marlies Ostermann and Mariangela Pellegrini and Jean-Louis Teboul and {De Waele}, Jan and Adrian Wong and Schaller, {Stefan J.}",

note = "Funding Information: Open Access funding enabled and organized by Projekt DEAL. This study was supported by the European Society of Intensive Care Medicine. Funding Information: SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study. GC reports research grants and personal fees as a Speakers' Bureau Member and Advisory Board Member from Integra, Neuroptics, Biogen, Idorsia and Invex Therapeutics all not related with this study. MO has received lecture fees and research funding from Baxter, Fresenius Medical and Biomerieux. JDW is supported by a Senior Clinical Investigator Grant from the Flanders Research Foundation (ref. 1881020N). JDW has consulted for Pfizer, MSD, ThermoFisher (honoraria paid to institution). All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = nov,

day = "14",

doi = "10.1186/s13613-023-01201-1",

language = "English",

volume = "13",

journal = "Annals of Intensive Care",

issn = "2110-5820",

publisher = "Springer International Publishing AG",

}

Kloss, P, Lindholz, M, Milnik, A, Azoulay, E, Cecconi, M, Citerio, G, De Corte, T, Duska, F, Galarza, L, Greco, M, Girbes, ARJ, Kesecioglu, J, Mellinghoff, J, Ostermann, M, Pellegrini, M, Teboul, J-L, De Waele, J, Wong, A & Schaller, SJ 2023, 'Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study', Annals of Intensive Care, vol. 13, 112 (2023). https://doi.org/10.1186/s13613-023-01201-1

TY - JOUR

T1 - Early mobilisation in critically ill COVID-19 patients

T2 - a subanalysis of the ESICM-initiated UNITE-COVID observational study

AU - Kloss, Philipp

AU - Lindholz, Maximilian

AU - Milnik, Annette

AU - Azoulay, Elie

AU - Cecconi, Maurizio

AU - Citerio, Giuseppe

AU - De Corte, Thomas

AU - Duska, Frantisek

AU - Galarza, Laura

AU - Greco, Massimiliano

AU - Girbes, Armand R. J.

AU - Kesecioglu, Jozef

AU - Mellinghoff, Johannes

AU - Ostermann, Marlies

AU - Pellegrini, Mariangela

AU - Teboul, Jean-Louis

AU - De Waele, Jan

AU - Wong, Adrian

AU - Schaller, Stefan J.

N1 - Funding Information: Open Access funding enabled and organized by Projekt DEAL. This study was supported by the European Society of Intensive Care Medicine. Funding Information: SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabeth Inc., Bayer AG and Siemens AG; these holdings have not affected any decisions regarding his research or this study. GC reports research grants and personal fees as a Speakers' Bureau Member and Advisory Board Member from Integra, Neuroptics, Biogen, Idorsia and Invex Therapeutics all not related with this study. MO has received lecture fees and research funding from Baxter, Fresenius Medical and Biomerieux. JDW is supported by a Senior Clinical Investigator Grant from the Flanders Research Foundation (ref. 1881020N). JDW has consulted for Pfizer, MSD, ThermoFisher (honoraria paid to institution). All other authors declare no competing interests. Publisher Copyright: © 2023, The Author(s).

PY - 2023/11/14

Y1 - 2023/11/14

N2 - 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).

AB - 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).

KW - Intensive care units

KW - Critical care

KW - Physical therapy specialty

KW - Bed rest

KW - Mobilisation

KW - COVID-19

KW - SARS-CoV-2

KW - Early ambulation

UR - http://www.scopus.com/inward/record.url?scp=85176341574&partnerID=8YFLogxK

U2 - 10.1186/s13613-023-01201-1

DO - 10.1186/s13613-023-01201-1

M3 - Article

SN - 2110-5820

VL - 13

JO - Annals of Intensive Care

JF - Annals of Intensive Care

M1 - 112 (2023)

ER -

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

Abstract

Bibliographical note

Keywords

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