Evaluating early mobilisation in critically ill COVID-19 patients: secondary analysis from the ESICM UNITE-COVID-II multicentre observational study.

Abstract

Background: Early mobilisation (EM) within the first 72 hours of ICU admission is essential for preventing ICU-acquired weakness; however, mobilisation rates remained low among mechanically ventilated (MV) COVID-19 patients during the pandemic waves. This study aimed to characterise the association between EM and 60-day outcomes.

Methods: A multicentre observational study conducted by the European Society of Intensive Care Medicine (ESICM) examined mobilisation strategies during the second COVID-19 wave (UNITE-COVIDed2021). All patients with confirmed SARS-CoV-2 infection who were in the ICU on the peak day between 1 January and 1 June 2021 were included. The analysis expanded on the UNITE-COVIDed2020 study, comparing the first and second COVID-19 waves using a combined dataset.

Results: Data from 2,053 patients during the second wave across 103 ICUs in 35 countries were analysed and compared with 4,190 patients from the first wave. EM was achieved in 801 (39%) vs. 1114 (27%), p < 0.001, respectively. In the combined cohort, MV on admission significantly reduced the likelihood of EM (OR 0.29, 95% CI: 0.25-0.33, p = 0.001). While EM did not improve ICU or hospital length of stay, it was associated with reduced 60-day mortality (OR 0.74, 95% CI: 0.64-0.86, p = 0.001) and transfer rates to other care facilities (OR 0.74, 95% CI: 0.59-0.94, p = 0.001).

Conclusion: EM is feasible and beneficial for critically ill COVID-19 patients. It was associated with reduced mortality and lower transfer rates to other care facilities, which underscores the critical role of EM in enhancing patient recovery during a pandemic.