Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis

Abstract

BackgroundPhysical therapy can prevent functional impairments and improve the quality of life of patients after hospital discharge. However, the effect of early mobilization on patients with a critical illness remains unclear. This study was performed to assess the evidence available regarding the effect of early mobilization on critically ill patients in the intensive care unit (ICU).MethodsElectronic databases were searched from their inception to March 21, 2019. Randomized controlled trials (RCTs) comprising critically ill patients who received early mobilization were included. The methodological quality and risk of bias of each eligible trial were assessed using the Cochrane Collaboration tool. Data were extracted using a standard collection form each included study, and processed using the Mantel-Haenszel (M-H) or inverse-variance (I-V) test in the STATA v12.0 statistical software.ResultsA total of 1,898 records were screened. Twenty-three RCTs comprising 2,308 critically ill patients were ultimately included. Early mobilization decreased the incidence of ICU-acquired weakness (ICU-AW) at hospital discharge (three studies, 190 patients, relative risk (RR): 0.60, 95% confidence interval (CI) [0.40, 0.90]; p = 0.013, I2 = 0.0%), increased the number of patients who were able to stand (one study, 50 patients, 90% vs. 62%, p = 0.02), increased the number of ventilator-free days (six studies, 745 patients, standardized mean difference (SMD): 0.17, 95% CI [0.02, 0.31]; p = 0.023, I2 = 35.5%) during hospitalization, increased the distance the patient was able to walk unassisted (one study, 104 patients, 33.4 (0–91.4) meters vs. 0 (0–30.4) meters, p = 0.004) at hospital discharge, and increased the discharged-to-home rate (seven studies, 793 patients, RR: 1.16, 95% CI [1.00, 1.34]; p = 0.046). The mortality (28-day, ICU and hospital) and adverse event rates were moderately increased by early mobilization, but the differences were statistically non-significant. However, due to the substantial heterogeneity among the included studies, and the low quality of the evidence, the results of this study should be interpreted with caution. Publication bias was not identified.ConclusionsEarly mobilization appears to decrease the incidence of ICU-AW, improve the functional capacity, and increase the number of ventilator-free days and the discharged-to-home rate for patients with a critical illness in the ICU setting.

Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial

“…In-bed immobilisation is a largely modifiable risk factor [43] and might be targeted with therapeutic interventions in critically ill patients at risk. However, current evidence on the benefit of early mobilisation is conflicting and needs further study [44]. Our randomised controlled trial likewise failed to reveal a superior intervention to increase strength at ICU discharge when comparing two different exercise regimes [22].…”

Mobilization practices in the ICU: A nationwide 1-day point- prevalence study in Brazil

“…The presence of muscle weakness has been associated with difficulties of weaning from mechanical ventilation, increased length of intensive care unit (ICU) and hospital stay, increased hospital costs, and long-term morbidity and mortality [7,8]. Early mobilization of critically ill patients may decrease the incidence of muscle weakness, and therefore improve outcomes [5][6][7][8][9].…”

Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019)

“…Another current meta-analysis using different definitions was able to show an effect of early mobilization [7]. Finally, Ding et al showed in their network metaanalysis that initiation of mobilization within 48-72 h in mechanical ventilation patients may be optimal to improve intensive care unit-acquired weakness [8].…”