TEAM: Treatment of invasively ventilated adults with Early Activity and Mobilisation

Background

Patients who are admitted to the Intensive Care Unit (ICU) with a life-threatening illness often receive invasive mechanical ventilation. This involves a tube inserted into the patient’s airway and attached to a ventilator (breathing machine) to assist with their breathing. Patients receiving this treatment often develop muscle weakness and wasting (ICU-acquired weakness) which is associated with longer stays in ICU and hospital and higher risk of death. The TEAM trial investigated whether early mobilisation of patients who are receiving invasive mechanical ventilation improved outcomes compared to the usual level of mobilisation (standard patient care).

Design

The TEAM trial was an international randomised clinical trial. 750 patients (46 from the UK) were randomly assigned to receive early mobilisation, which was performed daily by a physiotherapist and tailored to the individual patient, or the usual level of mobilisation (standard patient care) provided by the participating ICU. The primary outcome was the number of days patients spend alive and out of hospital in the 180 days after randomisation.

Results

The number of days patients included in the study spent alive and out of hospital at 180 days after randomisation did not differ between patients in the early mobilisation group compared with patients in the standard patient care group. The number of adverse events (an untoward medical occurrence) potentially caused by mobilising patients was higher in the early mobilisation group.

Conclusion

In patients receiving invasive mechanical ventilation, early mobilisation did not increase the number days patients spent alive and out of hospital compared with usual level of mobilisation in the ICU and out of hospital and was associated with more adverse events.



Who led the study?

Professor Carol Hodgson, Deputy Director, Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia

UK coordination: The Intensive Care National Audit & Research Centre are the UK sponsor organisation and coordinating centre. 

Funding

The study has funding from the National Health and Medical Research Council (NHMRC).

Publications

Presneill JJ, Bellomo R, Brickell K, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna T, Neto AS, Nichol A, Schaller SJ, Sivasuthan J, Tipping C, Webb S, Young P, Hodgson CL. Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. Crit Care Resusc 2021; 23(3):262-72. http://dx.doi.org/10.51893/2021.3.Oa3

Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med 2022; 387(19):1747-58. http://dx.doi.org/10.1056/NEJMoa2209083

Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med 2022; 387(19):1747-58. http://dx.doi.org/10.1056/NEJMoa2209083