Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study
Authors: Kloss Philipp , Lindholz Maximilian , Milnik Annette , Azoulay Elie , Cecconi Maurizio , Citerio Giuseppe , De Corte Thomas , Duska Frantisek , Galarza Laura , Greco Massimiliano , Girbes Armand R. J. , Kesecioglu Jozef , Mellinghoff Johannes , Ostermann Marlies , Pellegrini Mariangela , Teboul Jean-Louis , De Waele Jan , Wong Adrian , Schaller Stefan J. ,   for the ESICM UNITE COVID Investigators, Aires Buenos , Gira Alicia , Eller Philipp , Hamid Tarikul , Haque Injamam Ull , De Buyser Wim , Cudia Antonella , De Backer Daniel , Foulon Pierre , Collin Vincent , Van Hecke Jolien , De Waele Elisabeth , Van Malderen Claire , Mesland Jean-Baptiste , Biston Patrick , Piagnerelli Michael , Haentjens Lionel , De Schryver Nicolas , Van Leemput Jan , Vanhove Philippe , Bulpa Pierre , Ilieva Viktoria , Katz David , Binnie Alexandra , Geagea Anna , Tirapegui Fernando , Lago Gustavo , Graf Jerónimo , Perez-Araos Rodrigo , Vargas Patricio , Martinez Felipe , Labarca Eduardo , Franco Daniel Molano , Parra-Tanoux Daniela , Yepes David , Hammouda Ahmed , Elmandouh Omar , Azzam Ahmed , Hussein Aliae Mohamed , Galal Islam , Awad Ahmed K. , Azab Mohammed A. , Abdalla Maged , Assal Hebatallah , Alfishawy Mostafa , Ghozy Sherief , Tharwat Samar , Eldaly Abdullah , Ellervee Anneli , Reinhard Veronika , Chrisment Anne , Poyat Chrystelle , Badie Julio , Berdaguer Ferrari Fernando , Weiss Björn , Schellenberg Clara , Grunow Julius J , Lorenz Marco , Schaller Stefan J , Spieth Peter , Bota Marc , Fichtner Falk , Fuest Kristina , Lahmer Tobias , Herrmann Johannes , Meybohm Patrick , Markou Nikolaos , Vasileiadou Georgia , Chrysanthopoulou Evangelia , Papamichalis Panagiotis , Soultati Ioanna , Jog Sameer , Kalvit Kushal , Nainan Myatra Sheila , Krupa Ivan , Tharwat Aisa , Nichol Alistair , McCarthy Aine , Mahmoodpoor Ata , Tonetti Tommaso , Isoni Paolo , Spadaro Savino , Volta Carlo Alberto , Mirabella Lucia , Noto Alberto , Florio Gaetano , Guzzardella Amedeo , Paleari Chiara , Baccanelli Federica , Savi Marzia , Antonelli Massimo , De Pascale Gennaro , Vaccarini Barbara , Montrucchio Giorgia , Sales Gabriele , Donadello Katia , Gottin Leonardo , Nizzero Marta , Polati Enrico , De Rosa Silvia , Sulemanji Demet , Abusalama Abdurraouf , Elhadi Muhammed , Jesus Montelongo Felipe De , Gonzalez Daniel Rodriguez , Robles Victor Hugo Madrigal , Canedo Nancy , Chavez Alejandro Esquivel , Dendane Tarek , Grady Bart , de Jong Ben , van der Heiden Eveline , Thoral Patrick , van den Bogaard Bas , Spronk Peter E. , Achterberg Sefanja , Groeneveld Melanie , So Ralph K. L. , de Wijs Calvin , Scholten Harm , Beishuizen Albertus , Cornet Alexander D. , Reidinga Auke C. , Kranen Hetty , Mensink Roos , den Boer Sylvia , de Groot Marcel , Beck Oliver , Bethlehem Carina , van Bussel Bas , Frenzel Tim , de Jong Celestine , Wilting Rob , Mehagnoul-Schipper Jannet , Alasia Datonye , Kumar Ashok , Qayyum Ahad , Rana Muhammad , Jayyab Mustafa Abu , Sierra Rosario Quispe , Hernandez Aaron Mark , Taborda Lúcia , Anselmo Mónica , Ramires Tiago , Silva Catarina , Roriz Carolina , Morais Rui , Póvoa Pedro , Patricio Patricia , Pinto André , Santos Maria Lurdes , Costa Vasco , Cunha Pedro , Gonçalves Celina , Nunes Sandra , Camões João , Adrião Diana , Oliveira Ana , Omrani Ali , Maslamani Muna Al , elbuzidi Abdurrahmaan Suei , qudah Bara Mahmoud Al , Akkari Abdel Rauof , Alkhatteb Mohamed , Baiou Anas , Husain Ahmed , Alwraidat Mohamed , Saif Ibrahim Abdulsalam , Bakdach Dana , Ahmed Amna , Aleef Mohamed , Bintaher Awadh , Petrisor Cristina , Popov Evgeniy , Popova Ksenia , Dementienko Mariia , Teplykh Boris , Pyregov Alexey , Davydova Liubov , Vladislav Belskii , Neporada Elena , Zverev Ivan , Meshchaninova Svetlana , Sokolov Dmitry , Gavrilova Elena , Shlyk Irina , Poliakov Igor , Vlasova Marina , Aljuhani Ohoud , Alkhalaf Amina , Humaid Felwa Bin , Arabi Yaseen , Kuhail Ahmed , Elrabi Omar , Ghannam Madihah E. , Kansal Amit , Ho Vui Kian , Ng Jensen , García Raquel Rodrígez , Fraga Xiana Taboada , del Pilar García-Bonillo Mª , Padilla-Serrano Antonio , Cuadrado Marta Martin , Ferrando Carlos , Catalan-Monzon Ignacio , Frutos-Vivar Fernando , Jimenez Jorge , Rodríguez-Solis Carmen , Franquesa-Gonzalez Enric , Acosta Guillermo Pérez , Cabrera Luciano Santana , Parra Juan Pablo Aviles , Gonzalez Francisco Muñoyerro , del Carmen Conesa Maria Lorente , Varela Ignacio Yago Martinez , Pravia Orville Victoriano Baez , Delgado Maria Cruz Martin , de Cabo Carlos Munoz , Ioan Ana-Maria , Perez-Calvo Cesar , Santos Arnoldo , Abad-Motos Ane , Ripolles-Melchor Javier , Martin Belén Civantos , Teruel Santiago Yus , Lucas Juan Higuera , Ortiz Aaron Blandino , de Pablo Sánchez Raúl , Barrueco-Francioni Jesús Emilio , Espina Lorena Forcelledo , Bonell-Goytisolo José M. , Salaverria Iñigo , Mir Antonia Socias , Rodriguez-Ruiz Emilio , Valverde Virginia Hidalgo , Cubero Patricia Jimeno , Linde Francisca Arbol , Leganes Nieves Cruza , Romeu Juan Maria , Concha Pablo , Berezo-Garcia José Angel , Fraile Virginia , Cuenca-Rubio Cristina , Pérez-Torres David , Serrano Ainhoa , Valero Clara Martínez , Suner Andrea Ortiz , Larrañaga Leire , Legaristi Noemi , Ferrigno Gerardo , Khlafalla Safa , Bihariesingh-Sanchit Rosita , Zoerner Frank , Grip Jonathan , Kilsand Kristina , Mårtensson Johan , Österlind Jonas , von Seth Magnus , Berkius Johan , Ceruti Samuele , Glotta Andrea , Izdes Seval , Turan Işıl Özkoçak , Cosar Ahmet , Halacli Burcin , Dereli Necla , Yilmaz Mehmet , Akbas Türkay , Elay Gülseren , Eyüpoğlu Selin , Bílír Yelíz , Saraçoğlu Kemal Tolga , Kaya Ebru , Sahin Ayca Sultan , Ekren Pervin Korkmaz , Mengi Tuğçe , Suner Kezban Ozmen , Tomak Yakup , Eroglu Ahmet , Alsabbah Asad , Hanlon Katie , Gervin Kevin , McMahon Sean , Hagan Samantha , Higenbottam Caroline V , Mullhi Randeep , Poulton Lottie , Torlinski Tomasz , Gareth Allen , Truman Nick , Vijayakumar Gopal , Hall Chris , Jubb Alasdair , Cagova Lenka , Jones Nicola , Graham Sam , Robin Nicole , Cowton Amanda , Donnelly Adrian , Singatullina Natalia , Kent Melanie , Boulanger Carole , Campbell Zoë , Potter Elizabeth , Duric Natalie , Szakmany Tamas , Kviatkovske Orinta , Marczin Nandor , Ellis Caroline , Saha Rajnish , Sri-Chandana Chunda , Allan John , Mumelj Lana , Venkatesh Harish , Gotz Vera Nina , Cochrane Anthony , Ficial Barbara , Kamble Shruthi , Lumlertgul Nuttha , Oddy Christopher , Jain Susan , Crapelli Giulia Beatrice , Vlachou Aikaterini , Golden David , Garrioch Sweyn , Henning Jeremy , Loveleena Gupta , Davey Miriam , Grauslyte Lina , Salciute-Simene Erika , Cook Martin , Barling Danny , Broadhurst Phil , Purvis Sarah , Spivey Michael , Shuker Benjamin , Grecu Irina , Harding Daniel , Singatullina Natalia , Dean James T. , Nielsen Nathan D. , Al-Bayati Sama , Al-Sadawi Mohammed , Charron Mariane , Stubenrauch Peter , Santanilla Jairo , Wentowski Catherine , Rosenberger Dorothea , Eksarko Polikseni , Jawa Randeep 
Published: November 2023

Abstract
Background
Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave.

Methods
This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs.

Results
Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates.

Conclusions
Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility.
Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).