What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis

Nannan Ding, Zhigang Zhang, Caiyun Zhang, Li Yao, Liping Yang, Biantong Jiang, Yuchen Wu, Lingjie Jiang, Jinhui Tian, Nannan Ding, Zhigang Zhang, Caiyun Zhang, Li Yao, Liping Yang, Biantong Jiang, Yuchen Wu, Lingjie Jiang, Jinhui Tian

Abstract

Early mobilization has been proven to be an effective and safe intervention for preventing complications in mechanically ventilated patients; however, there is currently no unified definition of the optimal mobilization initiation time, hindering widespread clinical implementation. As clinicians are increasingly aware of the benefits of early mobilization, the definition of early mobilization is important. The purpose of this study was to evaluate the effects of different early mobilization initiation times on mechanically ventilated patients and rank these times for practical consideration. The Chinese Biomedical Literature Database, the Chinese Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library, Web of Science, and Embase databases, along with grey literature and reference lists, were searched for randomized control trials (RCTs) that evaluated the effects of early mobilization for improving patient outcomes; databases were searched from inception to October 2018. Two authors extracted data independently, using a predesigned Excel form, and assessed the quality of included RCTs according to the Cochrane Handbook (v5.1.0). Data were analyzed using Stata (v13.0) and Review Manager (v5.3.0). A total of 15 RCTs involving 1726 patients and seven mobilization initiation times (which were all compared to usual care) were included in our analysis. Network meta-analysis showed that mechanical ventilation for 48-72 h may be optimal to improve intensive care unit acquired weakness (ICU-AW) and reduce the duration of mechanical ventilation; however, there were no significant differences in length of ICU stay according to mobilization initiation time. The results of this study indicate that initiation of mobilization within 48-72 h of mechanical ventilation may be optimal for improving clinical outcomes for mechanically ventilated patients.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. RCT: Randomized control trial.
Fig 1. RCT: Randomized control trial.
Fig 2
Fig 2
Green: Low risk of bias; Yellow: Unclear risk of bias; Red: High risk of bias.
Fig 3. Network plot of included studies.
Fig 3. Network plot of included studies.
A: Network plot of ICU acquired weakness. B: Network plot of duration of mechanical ventilation. C: Network plot of ICU length of stay.
Fig 4. 95%CI: 95% Confidence Interval; (#):…
Fig 4. 95%CI: 95% Confidence Interval; (#): ICU admitted time.
Fig 5. SUCRA: Surface under the cumulative…
Fig 5. SUCRA: Surface under the cumulative ranking; (#): ICU admitted time.
Fig 6
Fig 6
A: mechanical ventilation ≤ 24h; B: mechanical ventilation with 24h-48h; C: mechanical ventilation with 48h-72h; D: mechanical ventilation > 96h; E: ICU admitted > 5days; F: ICU admitted > 7days; G: Usual care.

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Source: PubMed

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