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

Abstract

In Norway, almost 8500patients received mechanical ventilation in 2019. We have investigated the effect of early activity in mechanically ventilated adults in intensive care units on the duration of ventilation, weaning time from mechanical ventilation, mortality, length of stay, and adverse events. We conducted a systematic literature search for randomised controlled trials in nine databases. Two authors selected studies, extracted data and then rated the certainty of evidence according to the GRADE framework. A total of 3270 titles and abstracts were read, and 17 studies with 1805patients and a low-to-moderate risk of bias were included. The analyses showed that early mobilisation reduced both the mean duration of ventilation (-1.43 days; 95% CI -2.68 to -0.18, p = 0.02) and the ICU length of stay (-1.08 days; 95% CI -1.95 to -0.21, p = 0.02), with the certainty of evidence rated as moderate. Inspiratory muscle training had no effect on the duration of mechanical ventilation (-0.11; 95% CI -1.76 to 1.53, p = 0.89) or on the weaning time from mechanical ventilation (-0.33; 95% CI -1.31 to 0.65, p = 0.51), with the certainty of evidence rated as low. Neither early mobilisation nor inspiratory muscle training affected mortality. Few adverse events were reported. The analyses show that early mobilisation is safe and can shorten the duration of mechanical ventilation and the ICU length of stay, but has no effect on mortality. Inspiratory muscle training had no effect on any of the outcome measures.