Impact of Early Mobilization on Mechanical Ventilation Duration in Intubated Critically Ill Patients

Study Overview
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Brief Summary
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The purpose of the present study is to compare usual care in terms of mobilization performed to intubated ICU patients to a standardized program designed to deliver early mobilization at least 5 days a week. This study has a before / after design with a control group during the experimental phase. The first phase of the study corresponds to an observational phase during which every act of mobilization performed to the included patients is going to be documented. During this first study period, total duration of mechanical ventilation is going to be recorded for all the patients included. At the end of this first study period, the participating ICU are going to be randomized (Cluster randomization) in two groups either observational or experimental. The corresponding strategy is going to be applied to all the patients included during the second study period. During this second period, total duration of mechanical ventilation is also going to be recorded for all the patients included. The study hypothesis is that applying a protocolized early mobilization strategy increases the number of ventilator free-days during the 28 days after intubation in ICU patients.

Official Title
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Prospective, Randomized, Multi-center Trial to Assess the Impact of Early Mobilization on Mechanical Ventilation Duration in Intubated Critically Ill Patients

Conditions
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ICU Acquired Weakness

Intervention / Treatment
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* Procedure: Protocolized early mobilization in ICU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admission in intensive care unit Invasive ventilation for more than 24 hours Invasive ventilation for less than 48 hours Expected duration of invasive ventilation of more than 24 hours at the time of inclusion. Exclusion Criteria: Pregnancy Failure to obtain a consent from someone authorized Patient under law protection. Patient non-affiliated to a health care system. Active therapeutic limitation Hospitalisation for more than 7 days before intubation Admission in intensive care unit after a surgical procedure, burn or trauma Admission in intensive care unit because of neurological disease Previously known neuromuscular disease Bilateral lower limbs amputation BMI above 40 kg/m² Limitation in daily activities before ICU admission Chronic ventilation (more than 12h /24 hours) on tracheotomy before ICU admission Participation in another interventional clinical study related to mobilization or in an interventional clinical study which has mechanical ventilation duration as primary outcome Previous enrolment in the same phase of the EarlyMob study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard mobilization strategy<br> | |
| Experimental: protocolized early mobilization strategy<br> | Procedure: Protocolized early mobilization in ICU<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of days without mechanical ventilation (ventilator-free days) during the 28 days after intubation |  | 28 days after intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of Intensive Care Unit-acquired weakness with Manual Muscle Testing (MMT) scale |  | end of Intensive Care Unit stay, an expected average of 10 days | 
| The incidence and stage of pressure ulcers occurring during ICU stay with NPUAP scale |  | end of Intensive Care Unit stay, an expected average of 10 days | 
| The incidence of delirium with CAM-ICU scale |  | end of Intensive Care Unit stay, an expected average of 10 days | 
| Hospital stay duration |  | End of hospital stay, an expected average of 20 days | 
| Place where the patient is transferred at the end of the hospital stay |  | End of hospital stay, an expected average of 20 days | 
| The delay, in number of days between intubation and the first successful spontaneous breathing trial |  | End of Intensive Care Unit stay, an expected average of 10 days | 
| The incidence of extubation failure defined as re-intubation within 72 hours after the first extubation |  | end of Intensive Care Unit stay, an expected average of 10 days | 
| Time between intubation and the first stand-up position in days |  | end of Intensive Care Unit stay, an expected average of 10 days | 
| ICU stay duration |  | end of Intensive Care Unit stay, an expected average of 10 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Early mobilisation, Invasive ventilation, Ventilator free days, Intensive Care Unit