Treatment of Invasively Ventilated Adults With Early Activity and Mobilisation

Phase 3

Completed

• Conditions: Critically Ill, Mechanically Ventilated
• Interventions: Behavioral: Early activity and mobilisation

• Registration Number: NCT03133377
• Lead Sponsor: Australian and New Zealand Intensive Care Research Centre

Brief Summary

The aim of this study is to evaluate the effect of early activity and mobilisation during prolonged IMV on the composite outcome "days alive and out of hospital to day 180". The effect of the intervention on mortality, physical, cognitive and psychological function at 180 days, as well as cost-effectiveness of the intervention, will also be evaluated. The study will also explore process of care measures and baseline physiology and ICU mobility outcomes.

The hypothesis is that, in ICU patients expected to require prolonged IMV, early activity and mobilisation increases the number of days alive and at home to day 180 when compared with standard care.

Detailed Description

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 highest level of mobility. This will determine the dosage and type of exercise that will be delivered, led by the physiotherapist with assistance from the multidisciplinary team. For both groups, concomitant care will be guided by the treating clinician. In addition, all post-ICU patient management will be at the discretion of the patient's ward-based treating physicians.

Patients will be randomized via web-based system and de-identified data will be collected on the following: baseline demographics; comorbidities; sedatives, analgesics, corticosteroids and neuromuscular blockers; pain/sedation/delirium scores; tracheostomy, intubation and renal replacement therapy. The intervention will be administered during the ICU stay upto 28days and the Day 180 follow up will be conducted centrally.

Study Timeline

• Study First Submitted: 2017-04-10
• Study First Submitted QC: 2017-04-25
• Study First Posted: 2017-04-28
• Study Start: 2018-02-28
• Primary Completion: 2022-05-18
• Study Completion: 2022-11-10
• Status Verified: 2023-12
• Last Update Submitted: 2023-12-14
• Last Update Posted: 2023-12-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 750

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Early activity and Mobilisation intervention	Early activity and mobilisation	Patients will be assessed daily by an ICU physiotherapist using the ICU Mobility Scale (IMS) to determine the dosage and type of active exercises the patient will receive, using the early activity and mobilisation protocol. This protocol is hierarchical, with the objective of each intervention session beginning with the highest level of activity possible for the longest time possible, which then steps down to lower levels of activity if the patient fatigues. The intervention will be administered on all days in which the patient is admitted to ICU during the index hospitalisation, censored at 28days after.

Primary Outcome Measures

Name	Time	Method
Number of days alive and out of hospital	between randomisation and 180 days	Any days spent in rehabilitation or a nursing home counted as days in hospital

Secondary Outcome Measures

Name	Time	Method
Time from randomisation until death	From date of randomisation unitl date of death from all cause, censored at 180days
All-cause mortality	From date of randomisation up to180days.
ICU-free days	From date of randomisation until day 28	patients who die prior to day 28 will be assigned zero ICU-free days
Ventilator-free days	From date of randomisation until day 28	patients who die prior to day 28 will be assigned zero ventilator-free days
Generic function and disability measured with the World Health Organisation's Disability Assessment Schedule (WHODAS)	Assessed at 180days
Quality of life and health status measured using the European Quality of Life 5 Dimensions 5 Level (EQ5D-5L)	Assessed at 180days
Independent activities of daily living measured with Barthel Activities of Daily Living (ADL) Index and The Lawton Instrumental Activities of Daily Living Scale (IADL)	Assessed at 180days

Trial Locations

Locations (49)

St Vincent's Hospital; 🇮🇪 Dublin, Ireland

Galway Hospital; 🇮🇪 Galway, Ireland

Cabrini Health; 🇦🇺 Melbourne, Victoria, Australia

Epworth Richmond; 🇦🇺 Melbourne, Victoria, Australia

Wollongong Hospital; 🇦🇺 Wollongong, New South Wales, Australia

The Prince Charles Hospital; 🇦🇺 Chermside West, Queensland, Australia

The Charité; 🇩🇪 Berlin, Germany

Princess Alexandra Hospital; 🇦🇺 Woolloongabba, Queensland, Australia

Austin Health; 🇦🇺 Melbourne, Victoria, Australia

Redcliffe Hospital; 🇦🇺 Redcliffe, Queensland, Australia

Auckland City Hospital (CVICU); 🇳🇿 Auckland, New Zealand

Waikato Hospital; 🇳🇿 Hamilton, New Zealand

University Hospital Lewisham; 🇬🇧 Lewisham, United Kingdom

Auckland City Hospital (DCCM); 🇳🇿 Auckland, New Zealand

Tallaght Hospital; 🇮🇪 Tallaght, Ireland

Mater Health; 🇦🇺 Brisbane, Queensland, Australia

Mater Private Hospital; 🇦🇺 Brisbane, Queensland, Australia

Toowoomba Hospital; 🇦🇺 Toowoomba, Queensland, Australia

Morriston Hospital; 🇬🇧 Swansea, United Kingdom

Sunshine Coast University Hospital; 🇦🇺 Birtinya, Queensland, Australia

Caboolture Hospital; 🇦🇺 Caboolture, Queensland, Australia

Rockhampton Hospital; 🇦🇺 Rockhampton, Queensland, Australia

Klinikum rechts der Isar der Technischen Universität Mϋnchen; 🇩🇪 Munich, Germany

Tauranga Hospital; 🇳🇿 Tauranga, New Zealand

Royal Adelaide Hospital; 🇦🇺 Adelaide, South Australia, Australia

Royal Prince Alfred Hospital; 🇦🇺 Camperdown, New South Wales, Australia

St George Hospital; 🇦🇺 Sydney, New South Wales, Australia

John Hunter Hospital; 🇦🇺 Sydney, New South Wales, Australia

Royal North Shore Hospital; 🇦🇺 Sydney, New South Wales, Australia

Sir Charles Gairdner Hospital; 🇦🇺 Nedlands, Western Australia, Australia

Fiona Stanley Hospital; 🇦🇺 Perth, Western Australia, Australia

Royal Perth Hospital; 🇦🇺 Perth, Western Australia, Australia

St John of God Hospital; 🇦🇺 Subiaco, Western Australia, Australia

Launceston General Hospital; 🇦🇺 Launceston, Tasmania, Australia

Beacon Hospital; 🇮🇪 Dublin, Ireland

Nottingham University Hospitals; 🇬🇧 Nottingham, United Kingdom

Queen Elizabeth Hospital Woolwich; 🇬🇧 Woolwich, United Kingdom

St Vincent's Hospital Melbourne; 🇦🇺 Melbourne, Victoria, Australia

Western Health; 🇦🇺 Melbourne, Victoria, Australia

Alfred Hospital; 🇦🇺 Prahran, Victoria, Australia

Royal Melbourne Hospital; 🇦🇺 Melbourne, Australia

Frimley Park Hospital; 🇬🇧 Frimley, United Kingdom

Bristol Royal Infirmary; 🇬🇧 Bristol, United Kingdom

King's College Hospital; 🇬🇧 London, United Kingdom

Universitätsklinikum Leipzig; 🇩🇪 Leipzig, Germany

Wellington Hospital; 🇳🇿 Wellington, New Zealand

Royal Berkshire Hospital; 🇬🇧 Reading, United Kingdom

Royal Cornwall Hospital; 🇬🇧 Truro, United Kingdom

Geelong Hospital - Barwon Health; 🇦🇺 Geelong, Victoria, Australia