Early Rehabilitation for Patients with Septic Shock Associated with Mobilization During Their Intensive Care Unit Stay Without Worsening Mortality: A Multicenter, Prospective, Cohort Study.

Objectives

Early rehabilitation of critically ill patients has been reported to have benefits such as recovery of physical function at the time of discharge and increasing ventilator-free days, but there is also a risk of increasing the mortality rate. Whether early rehabilitation for patients with septic shock is associated with mobilization during their intensive care unit (ICU) stay without worsening the survival rate was investigated.

Design

The Best Available Treatment for septic SHOCK (BEAT-SHOCK) registry was a multicenter, prospective, cohort study.

Setting

Twenty ICUs in Japan. Patients: Patients with septic shock requiring high-dose norepinephrine (≥0.2 µg/kg/min) who were admitted to participating ICUs for more than 5 days from 2020 to 2022. Interventions: Early rehabilitation within 48 h after ICU admission for patients with septic shock. Measurements: The primary outcomes were sitting on the edge of the bed and standing within 14 days during the ICU stay, with secondary outcomes including 28-day mortality and 90-day mortality. Main

Results

Of 268 patients, 156 underwent early rehabilitation. The early rehabilitation and no early rehabilitation groups had similar median ages (72 vs 73 years) and Acute Physiology And Chronic Health Evaluation II scores (28 vs 26). Early rehabilitation had a significant effect on sitting on the edge of the bed within 14 days after ICU admission (adjusted hazard ratio [aHR] 1.66; 95% confidence interval [CI] 1.15-2.39). It also had a significant effect on standing within 14 days after ICU admission (aHR 2.20; 95%CI 1.29-3.77). The 90-day mortality rate was similar between the groups (early rehabilitation group: 28%, no early rehabilitation group: 23%, P=0.51), with an aHR of 1.27 (95%CI 0.78-2.08).

Conclusion

Early rehabilitation for patients with septic shock was associated with mobilization during their ICU stay without worsening the survival rate.[Trial registration: UMIN clinical trial registry, UMIN000038302. Registered November 1, 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043641].