https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00489-1/fulltext?utm_source=substack&utm_medium=email

Effect of early mobilisation on long term cognitive impairment in critical illness

• Early mobilisation could reduce the rates of cognitive impairment and other aspects of disability 1 year after critical illness.
• Patients who have received mechanical ventilation can have prolonged cognitive impairment for which there is no known treatment.
• Patients admitted to the adult medical surgical intensive care unit (ICU), at the University of Chicago (IL, USA), were recruited for the trial.
• Patients were randomly assigned to early physical and occupational therapy (early mobilisation) or usual care.
• The primary outcome was cognitive impairment 1 year after hospital discharge, measured with a Montreal Cognitive Assessment.
• The rate of cognitive impairment at 1 year with early mobilisation was 24% compared with 43% with usual care.
• Early mobilisation might be the first known intervention to improve long term cognitive impairment in ICU survivors after mechanical ventilation.
• The intervention group had fewer ICU acquired weaknesses and higher physical component scores on quality of life testing than did the usual care group.

Introduction

• Long term cognitive impairment affects about half of critically ill patients with respiratory failure or shock.
• A non-pharmacological approach known as early mobilisation has been shown to be safe and feasible, and might prevent long term cognitive impairment.
• Early mobilisation implements physical and occupational therapy within the first days of mechanical ventilation during critical illness.

Methods

• In this single-center, parallel, randomized controlled trial, patients admitted to the adult medical surgical ICU at the University of Chicago were screened for eligibility.
• Patients were randomly assigned to early mobilisation or usual care.
• The trial aimed to establish whether early mobilisation could reduce the rates of cognitive impairment and other aspects of disability 1 year after critical illness.

Background

• Long-term cognitive impairment after mechanical ventilation is a significant issue without known treatment.