ICU Early Mobility: Is it safe? Is it better?​

There is a common discussion or debate in the acute care PT world of whether or not early mobility in the ICU or with critical care patients is more beneficial and correlates to improved outcomes such as reduced hospital stay, improved mobility and strength outcomes at discharge, reduced risk of re-admission and others. This week’s iteration of the acute care crash course newsletter will go over the recent research findings in regard to early mobility in the ICU and whether it is beneficial or possibly more risk than the outcomes demonstrate.

Findings:

1. In a 2019 systematic review and meta analysis early mobility was found to:

• Decrease the incidence of ICU-AW
• Improve the functional capacity
• Increase the number of ventilator-free days
• Increased frequency of home discharge

But there was an increase in number of adverse events working with patients in an early mobility time frame.

2. In a 2021 systematic review and meta analysis which compared “early mobility” to “late mobility”:

• Improve score on SF-36 PFS and PCS
• Improve independence with mobility
• Improved time on 6MWT
• Did not affect ICU-AW incidence

These were when compared early vs late mobility, when early was compared to normal time frame in this study there were no significant differences aside from improved 6MWT with early mobility.

3. In a 2022 systematic review and meta analysis which just looked at the effects of early mobility in the ICU”:

• Reduced ICU length of stay by 0.8 days
• Reduced hospital length of stay by 1.75 days

4. In a 2022 RCT which compared early mobility vs standard mobilization to ventilated patients in the ICU:

• 20 minutes of therapy in the early mobility group vs 8 minutes in the normal mobility group
• Quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups
• Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group.

In this study there showed an increase in adverse events with increased early therapy and did not demonstrate significant improvement in outcomes after hospitalization with early mobility.

Citations:

• Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct 3;14(10):e0223185. doi: 10.1371/journal.pone.0223185. PMID: 31581205; PMCID: PMC6776357.
• Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care. 2021 Jan 6;25(1):16. doi: 10.1186/s13054-020-03446-9. PMID: 33407707; PMCID: PMC7789482.
• Wang YT, Lang JK, Haines KJ, Skinner EH, Haines TP. Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2022 Mar 1;50(3):375-388. doi: 10.1097/CCM.0000000000005285. PMID: 34406169.
• TEAM Study Investigators and the ANZICS Clinical Trials Group; Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med. 2022 Nov 10;387(19):1747-1758. doi: 10.1056/NEJMoa2209083. Epub 2022 Oct 26. PMID: 36286256.