Early activity in mechanically ventilated patients - a meta-analysis.

Area of Science:

• Critical Care Medicine
• Rehabilitation Therapy
• Evidence-Based Practice

Background:

• Mechanical ventilation is common in intensive care units (ICUs), with nearly 8,500 patients in Norway receiving it in 2019.
• Early activity and mobilization are potential interventions to improve outcomes for mechanically ventilated adults.

Purpose of the Study:

• To investigate the effects of early mobilization and inspiratory muscle training on outcomes in mechanically ventilated adult ICU patients.
• Key outcomes include duration of ventilation, weaning time, mortality, ICU length of stay, and adverse events.

Main Methods:

• A systematic literature search for randomized controlled trials was conducted across nine databases.
• Seventeen studies with 1,805 patients and low-to-moderate risk of bias were included after screening 3,270 titles and abstracts.
• The GRADE framework was used to rate the certainty of evidence.

Main Results:

• Early mobilization significantly reduced the mean duration of mechanical ventilation by 1.43 days (p=0.02) and ICU length of stay by 1.08 days (p=0.02), with moderate certainty of evidence.
• Inspiratory muscle training did not significantly affect ventilation duration or weaning time, with low certainty of evidence.
• Neither intervention demonstrated an effect on mortality, and few adverse events were reported.

Conclusions:

• Early mobilization is a safe and effective strategy to shorten mechanical ventilation duration and ICU length of stay.
• Inspiratory muscle training did not show benefits for the studied outcomes.
• Further research may explore optimal protocols for early mobilization in diverse ICU populations.