Table 2 Observational studies of early mobilization in the ICU
From: Clinical review: Early patient mobilization in the ICU
Study | Number of patients | Inclusion | Intervention | Primary outcome and key findings |
|---|---|---|---|---|
Bailey and colleagues [25] | 103 | Acute respiratory failure with MV >4 days | Sit on bed, sit on chair and ambulate | Early activity events: 1,449 (53% ambulate). Adverse events: <1% (fall to the knees with no injury, SBP >200 or <90 mmHg and desaturation <80%) |
Thomsen and colleagues [28] | 104 | Acute respiratory failure with MV >4 days | Early activity protocol; PROM, SOEOB, transfer to chair, walk | Ambulation (increased probability P <0.0001) |
Morris and colleagues [27] | 165 | Medical patients with acute respiratory failure requiring MV | Early activity protocol with four levels of activity: PROM, active resisted exercise and sitting, SOEOB, and transfer to chair | PT (more patients in the protocol group received PT versus usual care, 80% vs. 47%, P ≤0.001) |
Zanni and colleagues [29] | 19 | Medical patients ventilated >4 days | Individualized stretching, strengthening, balance training and functional activities (rolling, sitting, standing, walking, grooming, bathing) | Total consultations to PT and OT per patient: median 2 (1 to 4). Duration of rehabilitation (minutes): median 45 (34 to 47) |
Needham and colleagues [4] | 57 | Medical patients ventilated >4 days | Multidiscplinary team to focus on decreased sedation and increased PT and OT, particularly with functional mobility | Sedation (benzodiazepam reduced P <0.002). Rehabilitation treatments (increased P <0.001). Functional mobility (treatment involving sitting or greater increased P = 0.03) |
Bourdin and colleagues [26] | 20 | Medical patients in ICU ≥7 days and MV ≥2 days | Chair sitting, tilt table and walking | Physiological response: HR and RR increased with sitting, tilting up with arms unsupported and walking, oxygen saturation decreased with tilting up arms unsupported and walking |
Kho and colleagues [51] | 22 | Medical ICU adults receiving PT | Video games | Safety (zero adverse events). Feasibility (5% patients receiving PT used video games) |
Genc and colleagues [57] | 31 | Critically ill obese patients | Mobilization; SOEOB, standing, transfer to chair by walking, sitting in the chair | Transient episodes of altered SBP or HR in six patients. No deterioration in clinical status. SpO2 significantly increased after mobilization |
Leditschke and colleagues [58] | 106 | Mixed medical-surgical ICU | Active mobilization: MOS >30 seconds. Active transfer: transfer bed-chair against gravity. Passive transfer: passively lifted to out of bed (lifter, sling) | Two adverse events in 176 mobilization episodes (1.1%), which were hypotension requiring return to bed and fluid loading or vasopressors. Avoidable barriers to mobilization include femoral lines, sedation and scheduling procedures |