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Evaluating early mobilisation in critically ill COVID-19 patients: Secondary analysis from the ESICM UNITE-COVID-II multicentre observational study - 14/06/25

Doi : 10.1016/j.accpm.2025.101550 
Maximilian Markus a, Maximilian Lindholz a, b, Nils Daum a, Anne Pohrt c, Elie Azoulay d, Maurizio Cecconi e, f, Giuseppe Citerio g, h, Thomas De Corte i, j, Frantisek Duska k, l, Laura Galarza m, Massimiliano Greco e, f, Armand R.J. Girbes n, Jozef Kesecioglu o, Johannes Mellinghoff p, Marlies Ostermann q, Mariangela Pellegrini r, Jean-Louis Teboul s, Jan J. De Waele i, t, Adrian Wong u, Stefan J. Schaller a, v,

for the ESICM UNITE COVID Investigators

a Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany 
b Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Berlin, Germany 
c Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany 
d Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris University, Paris, France 
e Department of Biomedical Sciences, Humanitas University, Milan, Italy 
f IRCCS Humanitas Research Hospital, Milan, Italy 
g School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy 
h Department of Neuroscience, Neurointensive Care, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy 
i Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium 
j Department of Hematology, Ghent University Hospital, Ghent, Belgium 
k Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University, Prague, Czech Republic 
l FNKV University Hospital in Prague, Prague, Czech Republic 
m Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain 
n Department of Intensive Care Medicine, VUmc, Amsterdam, The Netherlands 
o Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands 
p School of Sports and Health Sciences, University of Brighton, Brighton, United Kingdom 
q Department of Critical Care, Guy's & St Thomas' Hospital, London, United Kingdom 
r Intensive Care Unit, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden 
s Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, France 
t Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium 
u Department of Critical Care, King's College Hospital, London, United Kingdom 
v Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria 

Corresponding author at: Medical University of Vienna, Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Spitalgasse 23, 1090 Vienna, Austria.Medical University of Vienna, Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care MedicineSpitalgasse 23Vienna1090Austria

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Highlights

Early mobilisation (EM) increased during 2nd pandemic wave significantly.
Mechanical ventilation is the main barrier for EM in a peak pandemic situation.
EM associated with lower mortality and discharge to facility in COVID-19 patients.

Il testo completo di questo articolo è disponibile in PDF.

Abstract

Background

Early mobilisation (EM) within the first 72 h of ICU admission is essential for preventing ICU-acquired weakness; however, mobilisation rates remained low among mechanically ventilated (MV) COVID-19 patients during the pandemic waves. This study aimed to characterise the association between EM and 60-day outcomes.

Methods

A multicentre observational study conducted by the European Society of Intensive Care Medicine (ESICM) examined mobilisation strategies during the second COVID-19 wave (UNITE-COVIDed2021). All patients with confirmed SARS-COV-2 infection who were in the ICU on the peak day between 1st January and 1st June 2021 were included. The analysis expanded on the UNITE-COVIDed2020 study, comparing the first and second COVID-19 waves using a combined dataset.

Results

Data from 2053 patients during the second wave across 103 ICUs in 35 countries were analysed and compared with 4190 patients from the first wave. EM was achieved in 801 (39%) vs. 1114 (27%), p < 0.001, respectively. In the combined cohort, MV on admission significantly reduced the likelihood of EM (OR 0.29, 95% CI: 0.25–0.33, p = 0.001). While EM did not improve ICU or hospital length of stay, it was associated with reduced 60-day mortality (OR 0.74, 95% CI: 0.64–0.86, p = 0.001) and transfer rates to other care facilities (OR 0.74, 95% CI: 0.59–0.94, p = 0.001).

Conclusion

EM is feasible and beneficial for critically ill COVID-19 patients. It was associated with reduced mortality and lower transfer rates to other care facilities, which underscores the critical role of EM in enhancing patient recovery during a pandemic.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Early mobilisation, COVID-19 patients, Multicentre study, ICUAW, ESICM, UNITE-COVID


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Vol 44 - N° 4

Articolo 101550- agosto 2025 Ritorno al numero
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