The following is a summary of “Should New Data on Rehabilitation Interventions in Critically Ill Patients Change Clinical Practice? Updated Meta-Analysis of Randomized Controlled Trials,” published in the March 2024 issue of Critical Care by Jiroutková et al.
Researchers conducted a retrospective analysis investigating how new data from 15 RCTs published (March 2020) strengthens the evidence on rehabilitation impact in ICU clinical outcomes.
They examined cycling exercises, neuromuscular electrical stimulation (NMES), protocolized physical rehabilitation (PPR), and functional electrical stimulation-assisted cycle ergometry (FESCE) against the standard of care.
The results showed 15 RCTs (including one on cycling, eight on NMES alone, four on PPR, and two on FESCE) enrolled 2,116 patients. An updated meta-analysis now includes 5664 patients. Exercise interventions did not affect mortality (OR, 1.00 [95% CI, 0.87–1.14]; n = 53 RCTs) but shortened mechanical ventilation duration (mean difference, –1.76 d [95% CI, –2.8 to –0.8 d]; n = 46) and ICU stay (-1.16 d [95% CI, –2.3 to 0.0 d]; n = 45). Notably, the PPR subgroup saw significant reductions in mechanical ventilation and ICU stay by a median of –1.7 days (95% CI, –3.2 to –0.2 d) and –1.9 days (95% CI, –3.5 to –0.2 d), respectively. Newly published trials provided consistent results and reduced overall heterogeneity.
Investigators concluded that ICU rehab didn’t impact death rates, but early ventilation rehab improved short-term ICU stays.
