Recently, the TEAM study (ClinicalTrials.gov number, NCT03133377) investigated whether early mobilisation in patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) could mitigate ICU-acquired weakness, increase survival and reduce disability. A total of 750 adult ICU patients were randomly assigned to receive either augmented early mobilisation (minimisation of sedation and daily physiotherapy) or usual care (the degree of mobilisation normally provided in each ICU). The primary outcome was the number of days patients were still alive and out of hospital at 180 days after randomisation. Although no significant differences in survival were observed between the 2 groups, it is important to note that increased early mobilisation did not improve quality of life, daily activities of life, disability, cognitive function or psychological function in surviving patients.1
The study had a number of limitations. Firstly, the patients included were relatively young and had a shorter mean ICU stay than in other similar studies, which might have limited the extrapolation of the results to other patient groups. In addition, a restrictive definition of early mobilisation was adopted - which might have limited the intensity and frequency of the intervention.
A previous study showed that early mobilisation was associated with improved muscle strength and functional capacity in patients on invasive mechanical ventilation in the ICU. However, it was also found that early mobilisation might increase the risk of adverse events, such as hypotension and tachycardia.2
Muscle deterioration in the ICU occurs due to a complex interplay of factors, including prolonged immobilisation, systemic inflammation, sedative use and neuromuscular dysfunction.3 In addition, the presence of chronic diseases and advanced age may also contribute to the development of ICU-acquired muscle weakness.4 It is therefore important to consider strategies that could mitigate these risk factors.
Although early rehabilitation has been shown to improve muscle function, reduce time on mechanical ventilation and decrease ICU stay,4 the results of this study do not show a significant difference between the early mobilisation group and the usual care group with regard to the number of days patients lived out of hospital at 180 days’ follow-up, In addition, the early mobilisation group experienced a higher number of adverse events, including arrhythmias, blood pressure changes and desaturation.5 Therefore, while early mobilisation may be beneficial in some respects, the risks and benefits need to be carefully assessed before implementing this in clinical practice.
FundingThis manuscript has not received any funding.
Conflict of interestThe authors have no conflict of interest to declare in the production of this study.
