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Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses.
Injury. 2019 Nov; 50(11):1809-1815.I

Abstract

OBJECTIVE

To determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation.

METHODS

We performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Study cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference -1.18 days, 95% CI, -2.17 - -0.19).

CONCLUSIONS

Few studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care.

Authors+Show Affiliations

Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada; Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada. Electronic address: greenrs@dal.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31526602

Citation

Higgins, Sean D., et al. "Early Mobilization of Trauma Patients Admitted to Intensive Care Units: a Systematic Review and Meta-analyses." Injury, vol. 50, no. 11, 2019, pp. 1809-1815.
Higgins SD, Erdogan M, Coles SJ, et al. Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. Injury. 2019;50(11):1809-1815.
Higgins, S. D., Erdogan, M., Coles, S. J., & Green, R. S. (2019). Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. Injury, 50(11), 1809-1815. https://doi.org/10.1016/j.injury.2019.09.007
Higgins SD, et al. Early Mobilization of Trauma Patients Admitted to Intensive Care Units: a Systematic Review and Meta-analyses. Injury. 2019;50(11):1809-1815. PubMed PMID: 31526602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. AU - Higgins,Sean D, AU - Erdogan,Mete, AU - Coles,Sherry J, AU - Green,Robert S, Y1 - 2019/09/09/ PY - 2019/05/06/received PY - 2019/09/04/revised PY - 2019/09/06/accepted PY - 2019/9/19/pubmed PY - 2020/7/22/medline PY - 2019/9/19/entrez KW - Early ambulation KW - Intensive care units KW - Occupational therapy KW - Physical therapy modalities KW - Rehabilitation KW - Wounds and injuries SP - 1809 EP - 1815 JF - Injury JO - Injury VL - 50 IS - 11 N2 - OBJECTIVE: To determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. METHODS: We performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Study cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference -1.18 days, 95% CI, -2.17 - -0.19). CONCLUSIONS: Few studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/31526602/Early_mobilization_of_trauma_patients_admitted_to_intensive_care_units:_A_systematic_review_and_meta_analyses_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(19)30524-8 DB - PRIME DP - Unbound Medicine ER -