Keibun Liu, MD. PhD
Postdoctoral Research Fellow
The Prince Charles Hospital, Critical Care Research Group, Japan
Disclosure information not submitted.
Title: Optimal timing of early mobilization for ICU patients with sepsis: An IPW-estimated analysis.
Background: Given the high mortality and morbidity of sepsis and sepsis-related functional disabilities during and after ICU stay, early mobilization is recommended for patients with sepsis. However, little is known about the optimal timing of mobilization to get the best outcomes.
Methods: This is a retrospective cohort study performed in a tertiary hospital between 2013-2017. We included ICU patients aged ≥18 years, who were retrospectively diagnosed with sepsis based on Sepsis-3. Early mobilization (EM) was defined as a level of sitting over the edge of the bed or higher within the first 3 days of ICU stay. Patients were divided into EM and non-EM groups. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay and ambulate independence at hospital discharge. We estimated the effects of early mobilization bystabilized inverse probability weighting (IPW). We then tested alternative definitions of EM by changing the cutoff in the number of days within which mobilization was achieved from 2 to 7 days. For each definition of EM, we performed the same analysis to investigate the optimal timing of mobilization.
Results: We identified a total of 303 septic patients, 100 in the EM group and 203 in the non-EM group. In the stabilized IPW model, the difference in the in-hospital mortality rate between EM and non-EM patients was −16.4% (7.1% vs 23.5%, [95%CI: −16.6% to −16.2%]). The difference in length of hospital stay was −7.5 days (36.8 vs 44.3 days, [95%CI: −7.8 to −7.2 days]) and the difference in the rate of ambulate independence at discharge was 22.3 % (67.6% vs 45.3%, [95%CI: 21.9%, 22.6%]). When alternative definitions of EM were used, the difference in in-hospital mortality rate between the EM group and the non-EM group was -13.5, -16.4, -16.7, -17.7, -15.4, and -15.9%, for 2-, 3-, 4-, 5-, 6-, and 7-day definitions, respectively. The difference in length of hospital stays was, −7.4, −7.5, −4.5, −0.2, −1.0, and −1.3 days, and the rate of ambulate independently at hospital discharge was 25.0, 22.3, 23.9, 24.4, 20.0, and 20.1 %, respectively.
Conclusions: For ICU patients with sepsis, early mobilization could significantly improve clinical outcomes. To maximize the effects of EM, the initiation of rehabilitation within 3-5 days of sepsis onset might be most beneficial.