Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice

Abstract

Early mobilization in the intensive care unit (ICU) is currently a hot topic, with morethan 15 randomized controlled trials (RCTs) in the past ten years including severalhigh impact publications [1]. However, the largest studies of early mobilization haveenrolled 300 patients, and the results of phase II randomized trials, pilot studies andobservational studies have been used to encourage practice change [2–5]. Thereare currently several international practice guidelines available, and early mobi-lization has consistently been reported as safe and feasible in the ICU setting [6].There is no doubt that this early intervention in ICU shows exciting potential. Thereported benefits of early mobilization, include reduced ICU-acquired weakness,improved functional recovery within hospital, improved walking distance at hos-pital discharge and reduced hospital length of stay [1]. However, medical researchhas repeatedly demonstrated that the results of pilot studies and phase II studiesmay not result in improved patient-centered outcomes when tested in a larger trial[7,8]. More importantly, it has been difficult to test this complex intervention, withseveral randomized trials delivering significantly less early mobilization than spec-ified in the study protocol [2,9] and observational studies reporting very low ratesof early mobilization during the ICU stay [10,11].This chapter summarizes the considerations for patient safety during early mo-bilization; including the physiological assessment of the patient, the consideration