Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial

Abstract

IntroductionNeuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk.MethodsThis was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.ResultsPhysiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p<0.001; time/session: 25min vs 18min, p<0.001) and had less days with sedation (p<0.001). Adverse events were rare (0.6%) and without consequences. There were no significant between-group differences in 6-Minute Walk Distance (experimental 123m (IQR 25–280) vs control 100m (IQR 0–300); p = 0.542) or functional independence (98 (IQR 66–119) vs 98 (IQR 18–115); p = 0.308). Likewise, no differences were found for the secondary outcomes, except a trend towards improved mental health in the experimental group after 6 months (84 (IQR 68–88) vs 70 (IQR 64–76); p = 0.023).ConclusionsEarly endurance and resistance training in mechanically ventilated, intensive care patients does not improve functional capacity or independence at hospital discharge compared to early standard physiotherapy but may improve mental health 6-months after critical care discharge.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00004347, registered on 10 September 2012.

Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial

“…However, current evidence on the benefit of early mobilisation is conflicting and needs further study [44]. Our randomised controlled trial likewise failed to reveal a superior intervention to increase strength at ICU discharge when comparing two different exercise regimes [22]. However, early mobilisation was part of both trial arms and thus not under direct investigation.…”

Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors

“…Groups of longitudinal trajectories of Physical Component Scores of the SF-36 (the most commonly reported 6-month HRQoL outcome measure [3,6,[29][30][31][32][33][34]) were clustered using the R-package TRAJ [35][36][37] and applied. Briefly, this package implements a 3-step procedure [36].…”

Determinants of self-reported unacceptable outcome of intensive care treatment 1 year after discharge

“…Since persistent mental symptoms mostly impacted self-reported unacceptable outcome, strategies to reduce mental sequelae are likely to benefit health acceptance in ICU survivors. ICU diaries, reduced use of sedatives, and early mobilization are proven interventions to decrease mental sequelae [ 31 – 33 ]. In addition, screening patients early after discharge can aid in identifying patients at risk of mental disabilities [ 34 ].…”