¹Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine and
²School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
³Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia;
⁴Critical Care Division, The George Institute for Global Health, Sydney, New South Wales, Australia;
⁵Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia;
⁶Data Analytics Research & Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia;
⁷Department of Critical Care and
⁸School of Medicine, University of Melbourne, Melbourne, Victoria, Australia;
⁹Department of Intensive Care and
¹⁰Intensive Care Unit and Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia;
¹¹Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia;
¹²Department of Physiotherapy, Royal Perth Hospital, Perth, Western Australia, Australia;
¹³Intensive Care Unit, St. John of God Hospital Subiaco, Perth, Western Australia, Australia;
¹⁴Intensive Care Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia;
¹⁵School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
¹⁶Intensive Care Unit, Wellington Hospital, Wellington, New Zealand;
¹⁷Medical Research Institute of New Zealand, Wellington, New Zealand;
¹⁸Physiotherapy Team, Te Whatu Ora – Capital, Coast, Wellington, New Zealand;
¹⁹School of Physiotherapy, University of Otago, Wellington, New Zealand;
²⁰Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany;
²¹Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany;
²²Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan;
²³Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland;
²⁴Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, United Kingdom;
²⁵Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil;
²⁶Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia;
²⁷Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia;
²⁸Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand;
²⁹School of Nursing, University of Auckland, Auckland, New Zealand; and
³⁰University College Dublin, Clinical Research Centre at St. Vincent’s University Hospital, Dublin, Ireland

Corresponding Author: Carol L. Hodgson

https://doi.org/10.1164/rccm.202312-2289OC PubMed: 38763167

Received: December 17, 2023

Accepted: April 16, 2024

Comments

Abstract

Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization.

Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial.

Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status.

Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0–153] vs. 147 [82–164]; P = 0.013) and higher 180-day mortality (30% vs. 18%; P = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0–144.5) in patients with diabetes and 146.5 (95.8–163.0) in patients without diabetes (P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67–7.61; P value for interaction = 0.001).

Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality.

Keywords: physiotherapy; mechanical ventilation; mortality; clinical trial

Correspondence and requests for reprints should be addressed to Carol L. Hodgson, Ph.D., Australian and New Zealand Intensive Care Research Centre, 553 St. Kilda Road, Melbourne, VIC 3004, Australia. E-mail: [email protected].

* A complete list of investigators in the TEAM trial is provided in the online supplement.

Supported by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand.

Authors Contributions: Conception and design: A.S.N., M.B., R.B., P.J.Y., and C.L.H. Acquisition of data: all authors. Data analysis: A.S.N. and M.B. Interpretation of data: all authors. Drafting the work or reviewing it: all authors. Final approval: all authors.

This article has a related editorial.

A data supplement for this article is available via the Supplements tab at the top of the online article.

Originally Published in Press as DOI: 10.1164/rccm.202312-2289OC on May 19, 2024

Author disclosures are available with the text of this article at www.atsjournals.org.

Early Mobilization in the ICU and Diabetes: A Bittersweet Concoction?

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American Journal of Respiratory and Critical Care Medicine

Abstract

Impact of High-Dose Early Mobilization on Outcomes for Patients with Diabetes: A Secondary Analysis of the TEAM Trial

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