Early Mobilization in the Intensive Care Unit

Abstract

As mortality from critical illness continues to decrease, focus has shifted to long-term outcomes of ICU survivors. Neuromuscular weakness is a common sequela of critical illness. This weakness prolongs duration of mechanical ventilation, increases ICU and hospital length of stay, increases mortality, and can persist for years after hospital discharge. The differential diagnosis of weakness in the ICU is long, and includes critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Immobilization and bed rest likely contribute to the development of CIP/CIM. Thus, early mobilization therapy has been suggested as an intervention to prevent or ameliorate ICU-acquired weakness. Early mobilization is safe, feasible, and associated with improved ICU outcomes. Emerging evidence suggests patients receiving early mobilization are more likely to be discharged home, making early mobilization therapy a potential mechanism to contain health care costs. Successful implementation of an early mobilization protocol requires changes in ICU culture and can be achieved using a structured quality improvement framework.