Elsevier

Journal of Critical Care

Volume 30, Issue 4, August 2015, Pages 664-672
Journal of Critical Care

Physiotherapy and mobilization
Early mobilization in the critical care unit: A review of adult and pediatric literature

https://doi.org/10.1016/j.jcrc.2015.03.032Get rights and content

Abstract

Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.

Section snippets

Consequences of immobility in the critically ill

Typical critical care interventions that promote immobilization include the administration of analgesics and sedatives to facilitate mechanical ventilation and reduce pain, agitation, and/or anxiety [4], [5]. Immobility is associated with ICU delirium, impaired exercise capacity, ICU-acquired weakness (ICU-AW), and poorer functional outcomes and quality of life [6], [7]. Intensive care unit–acquired weakness is categorized by both axonal nerve degeneration and myosin loss, and is believed to be

Early mobilization in critically ill patients

Research on early mobilization is growing in the adult population, whereas studies in the pediatric population are still in their infancy. Thirteen prospective studies have been conducted in adults [3], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], but only 3 are randomized controlled trials [30], [34], [39]. A recent Canadian survey, composed of 198 adult ICUs, indicated that although 71% of the units prioritized early mobilization, only 38% of the ICUs had

Restrictive parameters and contraindications

Patient safety is paramount in any exercise intervention. Patients with high illness severity, coma, and/or delirium are particularly vulnerable; and the utmost care must be undertaken during exercise interventions [75]. A survey of Canadian PICU practices found that medical instability, risk of device and/or catheter dislodgement, and mechanical ventilation are perceived barriers to mobilization [43]. Despite literature that demonstrates the safety of early mobilization in high-acuity

Summary

Our review provides an overview of that which is currently known about early mobilization and illuminates the areas in which the field is lacking. To date, what is clearly understood about early mobilization is that it is safe, feasible, and effective; however, early mobilization research in critically ill adults is insufficient, whereas pediatric research is even less complete. More focused work on advancing the continuum of mobilization (from early passive exercise transitioning to active and

Acknowledgements

The authors are funded by the AMOSO/HAHSO Innovation Funds (Wee-Cover Study Group) and the Schulich School of Medicine and Dentistry, Collaborative Research Seed Grant (TERMS Study Group).

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