Evaluating early mobilisation in critically ill COVID-19 patients: Secondary analysis from the ESICM UNITE-COVID-II multicentre observational study

Maximilian Markus; Maximilian Lindholz; Nils Daum; Anne Pohrt; Elie Azoulay; Maurizio Cecconi; Giuseppe Citerio; Thomas De Corte; Frantisek Duska; Laura Galarza; Massimiliano Greco; Armand R J Girbes; Jozef Kesecioglu; Johannes Mellinghoff; Marlies Ostermann; Mariangela Pellegrini; Jean-Louis Teboul; Jan J De Waele; Adrian Wong; Stefan J Schaller; ESICM UNITE COVID Investigators

doi:10.1016/j.accpm.2025.101550

Evaluating early mobilisation in critically ill COVID-19 patients: Secondary analysis from the ESICM UNITE-COVID-II multicentre observational study

Anaesth Crit Care Pain Med. 2025 May 17;44(4):101550. doi: 10.1016/j.accpm.2025.101550. Online ahead of print.

Authors

Maximilian Markus¹, Maximilian Lindholz², Nils Daum¹, Anne Pohrt³, Elie Azoulay⁴, Maurizio Cecconi⁵, Giuseppe Citerio⁶, Thomas De Corte⁷, Frantisek Duska⁸, Laura Galarza⁹, Massimiliano Greco⁵, Armand R J Girbes¹⁰, Jozef Kesecioglu¹¹, Johannes Mellinghoff¹², Marlies Ostermann¹³, Mariangela Pellegrini¹⁴, Jean-Louis Teboul¹⁵, Jan J De Waele¹⁶, Adrian Wong¹⁷, Stefan J Schaller¹⁸; ESICM UNITE COVID Investigators

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Radiology, Berlin, Germany.
³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.
⁴ Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris University, Paris, France.
⁵ Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy.
⁶ School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Neuroscience, Neurointensive Care, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.
⁷ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Hematology, Ghent University Hospital, Ghent, Belgium.
⁸ Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University, Prague, Czech Republic; FNKV University Hospital in Prague, Prague, Czech Republic.
⁹ Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
¹⁰ Department of Intensive Care Medicine, VUmc, Amsterdam, The Netherlands.
¹¹ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹² School of Sports and Health Sciences, University of Brighton, Brighton, United Kingdom.
¹³ Department of Critical Care, Guy's & St Thomas' Hospital, London, United Kingdom.
¹⁴ Intensive Care Unit, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
¹⁵ Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, France.
¹⁶ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹⁷ Department of Critical Care, King's College Hospital, London, United Kingdom.
¹⁸ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany; Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria. Electronic address: stefan.schaller@meduniwien.ac.at.

PMID: 40389154
DOI: 10.1016/j.accpm.2025.101550

Abstract

Background: Early mobilisation (EM) within the first 72 h of ICU admission is essential for preventing ICU-acquired weakness; however, mobilisation rates remained low among mechanically ventilated (MV) COVID-19 patients during the pandemic waves. This study aimed to characterise the association between EM and 60-day outcomes.

Methods: A multicentre observational study conducted by the European Society of Intensive Care Medicine (ESICM) examined mobilisation strategies during the second COVID-19 wave (UNITE-COVIDed2021). All patients with confirmed SARS-COV-2 infection who were in the ICU on the peak day between 1^st January and 1^st June 2021 were included. The analysis expanded on the UNITE-COVIDed2020 study, comparing the first and second COVID-19 waves using a combined dataset.

Results: Data from 2053 patients during the second wave across 103 ICUs in 35 countries were analysed and compared with 4190 patients from the first wave. EM was achieved in 801 (39%) vs. 1114 (27%), p < 0.001, respectively. In the combined cohort, MV on admission significantly reduced the likelihood of EM (OR 0.29, 95% CI: 0.25-0.33, p = 0.001). While EM did not improve ICU or hospital length of stay, it was associated with reduced 60-day mortality (OR 0.74, 95% CI: 0.64-0.86, p = 0.001) and transfer rates to other care facilities (OR 0.74, 95% CI: 0.59-0.94, p = 0.001).

Conclusion: EM is feasible and beneficial for critically ill COVID-19 patients. It was associated with reduced mortality and lower transfer rates to other care facilities, which underscores the critical role of EM in enhancing patient recovery during a pandemic.

Keywords: COVID-19 patients; ESICM; Early mobilisation; ICUAW; Multicentre study; UNITE-COVID.