Treatment of Invasively Ventilated Adults With Early Activity and Mobilisation

Launched by AUSTRALIAN AND NEW ZEALAND INTENSIVE CARE RESEARCH CENTRE · Apr 25, 2017

Keywords

ClinConnect Summary

The TEAM Trial is a definitive phase III multi-centre randomised controlled trial in mechanically ventilated patients. Supported by compelling preliminary data, the trial will determine whether early activity and mobilisation during mechanical ventilation improves days alive and at home at 6 months compared to standard care. Recruiting 750 patients, this will be the largest trial ever conducted of early mobilisation.

Patients allocated to the early activity and mobilisation protocol (intervention group) will be assessed by a physiotherapist daily during the ICU stay to determine the highes...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Aged 18 years or older.
• • 2. Intubated and expected to remain invasively mechanically ventilated the day after tomorrow.
• 3. Sufficient cardiovascular stability to make mobilisation potentially possible, as indicated by:
• • 1. the absence of current brady-arrhythmia requiring pharmacological support
• • 2. a current ventricular rate ≤ 150 bpm
• • 3. most recent lactate ≤ 4.0 mmol/L
• • 4. current combined noradrenaline/adrenaline infusion rate of ≤ 0.2 mcg/kg/min, OR if noradrenaline/adrenaline infusion rate has increased by more than 25% in the last 6 hours, dose must be \<0.1 mcg/kg/min.
• • 5. most recent cardiac index ≥ 2.0 L/min/m2 (where measured)
• • 6. no current requirement for VA ECMO
• 4. Sufficient respiratory stability to make mobilisation potentially possible, as indicated by:
• • 1. current FiO2 ≤ 0.6
• • 2. current PEEP ≤ 16 cm H20
• • 3. an absence of current requirement for NO, prone ventilation, neuromuscular blockers, ventilation, prostacyclin, VV ECMO or HFOV
• • 4. current RR ≤ 45 bpm
• Exclusion Criteria:
• • 1. Dependent for activities of daily living in the month prior to current ICU admission (gait aids are acceptable).
• • 2. Documented cognitive impairment.
• • 3. Proven or suspected acute primary brain pathology (e.g. traumatic brain injury, stroke, hypoxic brain injury).
• • 4. Proven or suspected spinal cord injury or other neuromuscular disease that will result in permanent or prolonged weakness (not including ICU acquired weakness).
• • 5. Has rest in bed orders and/or has bilateral non-weight bearing orders for the lower limbs.
• • 6. Life expectancy less than 180 days due to a chronic or underlying medical condition.
• • 7. Death is deemed inevitable as a result of the current illness and either the patient or treating clinical or substitute decision maker are not committed to full active treatment.
• • 8. Unable to communicate in the official local language.
• • 9. This is not the first ICU admission in the index hospital admission.
• • 10. Fulfilled all inclusion criteria and none of the exclusion criteria ≥ 72 hours