Remote Multicomponent Rehabilitation in Intensive Care Unit Survivors: A Randomized Clinical Trial

# Remote Multicomponent Rehabilitation in Intensive Care Unit Survivors: A Randomized Clinical Trial *Published: 2026 May 18* reported receiving grant funding from the UK National Institute for Health and Care Research (NIHR) for other trials. Dr Connolly reported receiving grant funding from the NIHR for other clinical trials. Dr Underwood reported being chief investigator or coinvestigator on multiple previous and current research grants from the NIHR, the Australian National Health and Medical Research Council, and the Norwegian Research Council; receiving support from Stryker Ltd; being director and shareholder of Clinvivo Ltd; and receiving some salary support from University Hospitals Coventry and Warwickshire. Dr Dark reported receiving grants and salary support from the NIHR. Dr Murphy reported receiving funding support from the Department for the Economy, Northern Ireland. Dr McAuley reported receiving grants from Innovate UK, Novavax, the Northern Ireland Health and Social Care Research and Development Agency, Randox, and Wellcome Trust; receiving personal fees from Bayer, Aptarion, Direct Biologics, Novartis, MSD, and Healios; having a patent for novel treatment for inflammatory disease issued to Queen’s University Belfast; serving as scientific director for programs at the NIHR; and that spouse has received consultancy fees from Insmed and the California Institute for Regenerative Medicine. No other disclosures were reported. 27. JAMA. 2026 May 18:e266025. doi: 10.1001/jama.2026.6025. Online ahead of print. 4% Tetrasodium EDTA to Prevent Central Venous Access Device-Associated Complications: A Randomized Clinical Trial. Ornowska M(1), Wittmann J(2)(3), Blitz S(4), Wong H(4)(5), Vazquez-Grande G(6), Mitra AR(7), Jang W(7), Wood G(7), Ovakim D(7), Forrest D(7), Rohrs E(1)(3), Reynolds S(1)(2)(3)(7). Author information: (1)Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. (2)Department of Critical Care, Royal Columbian Hospital, New Westminster, British Columbia, Canada. (3)Fraser Health Authority, Surrey, British Columbia, Canada. (4)University of British Columbia Centre for Advancing Health Outcomes, Providence Healthcare, Vancouver, British Columbia, Canada. (5)School of Population and Public Health, University of British Columbia, Vancouver, Canada. (6)Section of Critical Care, University of Manitoba, Winnipeg, Canada. (7)Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada. Comment in doi: 10.1001/jama.2026.7399. ## IMPORTANCE Use of central venous access devices (CVADs) can result in catheter-associated bloodstream infection, catheter occlusion, and catheter-related venous thrombosis. EDTA is a potent anticoagulant, antimicrobial, and antibiofilm agent that can be instilled into inactive CVAD ports as a locking fluid to decrease the risk of infection and maintain patency. ## OBJECTIVE To determine whether a 4% tetrasodium EDTA (t-EDTA) locking fluid reduces CVAD-associated infections, occlusions, and thrombolytic use in adults treated in an intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Pragmatic, triple-blind, multicenter, cluster-randomized crossover trial including patients older than 18 years in the ICU with a CVAD in place and at least 1 lumen not in use. The trial was conducted in 6 Canadian hospitals (3 community hospitals and 3 academic centers). The first patient was enrolled on March 22, 2022, and the date of last follow-up occurred on September 25, 2024. ## INTERVENTIONS The ICUs were randomized to use prefilled, identical, masked syringes containing 2.5 mL of t-EDTA (intervention) or control locking fluid (saline or 4% citrate for hemodialysis lines) for all trial participants over a 3.5-month period. After a 1-month follow-up period, ICUs crossed over to the opposing treatment group for another 3.5 months, with a subsequent 1-month follow-up. MAIN OUTCOMES AND MEASURES The primary outcome was a composite incidence rate of CVAD-associated bloodstream infection, catheter occlusion requiring alteplase use, and/or catheter removal due to occlusion. Three of the 8 prespecified secondary outcomes included incidence rates of each component of the primary outcome separately. ## RESULTS Of the 1574 eligible patients, 1468 (mean age, 60 [SD, 16.0] years; 37.7% female) were included in the analysis (696 receiving t-EDTA and 772 receiving control). The incidence rate of primary outcome events was 13.1 per 1000 catheter-days (74 events) in the t-EDTA group vs 19.9 per 1000 catheter-days (126 events) in the control group. In adjusted multivariate analysis, the incidence rate of the composite outcome was lower among patients receiving t-EDTA vs control (rate ratio, 0.68; 95% CI, 0.47-0.96; P = .03). Among the 3 components of the primary outcome, only the secondary outcome of CVAD occlusion requiring administration of alteplase significantly differed between the groups, with lower rates in the t-EDTA group vs control (66 vs 112; incidence rate, 11.67 and 17.73 per 1000 catheter-days, respectively; rate ratio, 0.66; 95% CI, 0.46-0.96). CONCLUSIONS AND RELEVANCE Compared with control locking solution, use of 4% t-EDTA locking solution for CVADs reduced the incidence of a composite outcome of CVAD-associated bloodstream infection, catheter occlusion requiring alteplase use, and catheter removal due to occlusion among adult patients in the ICU. ## TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04548713. DOI: 10.1001/jama.2026.6025 PMCID: PMC13184800 DOI: 10.1001/jama.2026.7401