Studies are also demonstrating improved clinical outcomes
with early mobility. An early mobility protocol that
provided rehabilitation therapy 7 days per week via a dedicated
mobility team—nurse, nurse assistant, and physical
therapist—showed a trend toward decreased hospital
mortality (12.1% versus 18.2%, P = 0.125). Early mobilization
was also associated with decreased LOS in the ICU
(5.5 days versus 6.9 days, P = 0.025) and decreased LOS in
the hospital (11.2 days versus 14.5 days, P = 0.006) after
adjusting for differences in body mass index, APACHE II
score, and vasopressor use.168
Despite the early data showing benefits, early mobilization
of critically ill patients in the ICU has unique challenges
and concerns. One barrier has been the culture regarding
the need for bed rest and activity restriction during critical
illness because of the presence of endotracheal tubes, vascular
access devices, or other medical equipment. However,
studies have demonstrated that mobilization of patients
who are mechanically ventilated can be safely performed.
Bailey and colleagues showed that in a study of 103 patients
in the ICU involving over 1400 activity events, only 14
minor events occurred in 9 patients, and no unanticipated
extubations or events occurred, requiring additional cost
or increased LOS in the hospital.169 Morris and colleagues
obtained similar results in their trial of early mobility on
145 patients who were intubated in the ICU. They reported
no incidents of accidental removal of devices.168
It is becoming more apparent that early mobility is
feasible in ICUs with a supportive culture, and early may
be significantly sooner than what has been customary.
Schweickert
and colleagues studied beginning therapy an
average of 1.5 days after intubation.170 The group of patients
who were mobilized early were more likely to be functionally
independent when they left the hospital (59% versus
35%, P = 0.02), and more patients were able to go directly
home (43% versus 24%, P = 0.06). Patients in the intervention
group had shorter duration of delirium (median 2.0
days versus 4.0 days, P = 0.02) and more ventilator-free days
(23.5 days versus 21.1 days, P = 0.05) during the 28-day
follow-up period than did study control participants.
Early mobilization in the ICU requires a multidisciplinary
team approach.171 Targets for culture change
include gaining support from institutional leaders and
bedside clinicians.172 Careful communication between
physicians, nurses, and therapists is paramount. More
research is necessary to identify whether specific groups
of patients will benefit from early mobilization more than
others, the appropriate amount of mobilization, and the
absolute and relative contraindications. The potential for
early mobilization to affect mortality seems promising.
with early mobility. An early mobility protocol that
provided rehabilitation therapy 7 days per week via a dedicated
mobility team—nurse, nurse assistant, and physical
therapist—showed a trend toward decreased hospital
mortality (12.1% versus 18.2%, P = 0.125). Early mobilization
was also associated with decreased LOS in the ICU
(5.5 days versus 6.9 days, P = 0.025) and decreased LOS in
the hospital (11.2 days versus 14.5 days, P = 0.006) after
adjusting for differences in body mass index, APACHE II
score, and vasopressor use.168
Despite the early data showing benefits, early mobilization
of critically ill patients in the ICU has unique challenges
and concerns. One barrier has been the culture regarding
the need for bed rest and activity restriction during critical
illness because of the presence of endotracheal tubes, vascular
access devices, or other medical equipment. However,
studies have demonstrated that mobilization of patients
who are mechanically ventilated can be safely performed.
Bailey and colleagues showed that in a study of 103 patients
in the ICU involving over 1400 activity events, only 14
minor events occurred in 9 patients, and no unanticipated
extubations or events occurred, requiring additional cost
or increased LOS in the hospital.169 Morris and colleagues
obtained similar results in their trial of early mobility on
145 patients who were intubated in the ICU. They reported
no incidents of accidental removal of devices.168
It is becoming more apparent that early mobility is
feasible in ICUs with a supportive culture, and early may
be significantly sooner than what has been customary.
Schweickert
and colleagues studied beginning therapy an
average of 1.5 days after intubation.170 The group of patients
who were mobilized early were more likely to be functionally
independent when they left the hospital (59% versus
35%, P = 0.02), and more patients were able to go directly
home (43% versus 24%, P = 0.06). Patients in the intervention
group had shorter duration of delirium (median 2.0
days versus 4.0 days, P = 0.02) and more ventilator-free days
(23.5 days versus 21.1 days, P = 0.05) during the 28-day
follow-up period than did study control participants.
Early mobilization in the ICU requires a multidisciplinary
team approach.171 Targets for culture change
include gaining support from institutional leaders and
bedside clinicians.172 Careful communication between
physicians, nurses, and therapists is paramount. More
research is necessary to identify whether specific groups
of patients will benefit from early mobilization more than
others, the appropriate amount of mobilization, and the
absolute and relative contraindications. The potential for
early mobilization to affect mortality seems promising.
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