• Am. J. Respir. Crit. Care Med. · May 2024

    Impact of High Dose Early Mobilization on Outcomes for Patients with Diabetes: A Secondary Analysis of the TEAM Trial.

    • Ary Serpa Neto, Michael Bailey, Daniel Seller, Alicia Agli, Rinaldo Bellomo, Kathy Brickell, Tessa Broadley, Heidi Buhr, Belinda J Gabbe, Doug W Gould, Meg Harrold, Alisa M Higgins, Sally Hurford, Theodore J Iwashyna, Alistair D Nichol, Jeffrey J Presneill, Stefan J Schaller, Janani Sivasuthan, Claire J Tipping, Alex Poole, Rachael Parke, Scott Bradley, Steven Webb, Sophia Zoungas, Paul J Young, and Carol L Hodgson.
    • Monash University Faculty of Medicine Nursing and Health Sciences, 22457, ANZIC-RC, Prahran, Victoria, Australia; ary.serpaneto@monash.edu.
    • Am. J. Respir. Crit. Care Med. 2024 May 19.

    RationalePatients with diabetes represent almost 20% of all ICU admissions and might respond differently to high dose early active mobilization.ObjectivesTo assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial.MethodsAll TEAM trial patients were included. The primary outcome was days alive and out of hospital at day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at day 180. Logistic and median regression models were used to explore the effect of high dose early mobilization on outcomes by diabetes status.Measurements And Main ResultsAll 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had a lower number of days alive and out of hospital at day 180 (124 [0-153] vs. 147 [82-164], p = 0.013), and higher 180-day mortality (30% vs. 18%, p = 0.044). In patients receiving high dose early mobilization, days alive and out of hospital at day 180 was 73.0 (0.0 - 144.5) in patients with diabetes and 146.5 (95.8 - 163.0) in patients without diabetes (p for interaction = 0.108). However, in patients with diabetes, high dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio 3.47; 95% confidence interval [CI], 1.67-7.61, p value for interaction, 0.001).ConclusionsIn this secondary analysis of the TEAM trial, in patients with diabetes, a high dose early mobilization strategy did not significantly decrease the number of days alive and out of hospital at day 180 but it increased 180-day mortality.

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