BACKGROUND: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. METHODS: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. RESULTS: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. CONCLUSIONS: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).

Charité Universitätsmedizin Berlin corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Anesthesiology and Intensive Care Medicine Berlin Germany

Department Neuroscience Neurointensive Care IRCCS Fondazione San Gerardo dei Tintori Monza Italy

Department of Anaesthesia and Intensive Care 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele 20072 Milan Italy

Department of Critical Care King's College Hospital London UK

Department of Critical Care King's College London Guy's and St Thomas' Hospital London UK

Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium

Department of Intensive Care Medicine Research VUmc Intensive Care UMC Location VUmc VU Amsterdam Amsterdam The Netherlands

Department of Intensive Care Medicine University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Internal Medicine and Pediatrics Faculty of Medicine and Health Sciences Ghent University Ghent Belgium

FNKV University Hospital Prague Prague Czech Republic

Hedenstierna Laboratory Department of Surgical Science Uppsala University Uppsala Sweden

Intensive Care Unit AnOpIVA Akademiska Sjukhuset Uppsala Sweden

Intensive Care Unit Hospital General Universitario de Castellón Castellón de La Plana Spain

IRCCS Humanitas Research Hospital Via Manzoni 56 Rozzano 20089 Milan Italy

Médecine Intensive et Réanimation APHP Saint Louis Hospital Paris University Paris France

Research Platform Molecular and Cognitive Neurosciences Department of Biomedicine University of Basel Basel Switzerland

School of Medicine and Surgery University of Milano Bicocca Milan Italy

School of Sports and Health Sciences University of Brighton Brighton UK

Service de Médecine Intensive Réanimation Hôpital Bicêtre AP HP Université Paris Saclay Inserm UMR S_999 Le Kremlin Bicêtre France

Technical University of Munich School of Medicine Klinikum rechts der Isar Department of Anesthesiology and Intensive Care Medicine Munich Bavaria Germany

Université de Paris Paris France

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NCT04836065