Patient Outcomes Improved by Early Mobilization in the ICU

A new study has found that the functional status of intensive care unit (ICU) patients may be restored earlier by performing daily interruptions in sedation, paired with mobilization and exercise directed by physical and occupational therapists.

Researchers at the University of Pennsylvania Medical Center (UPenn, Philadelphia, USA) randomly assigned 104 patients by computer-generated, permuted block randomization to early exercise and mobilization (physical and occupational therapy) during periods of daily interruption of sedation (49 patients) or to a control group that underwent daily interruption of sedation with therapy as ordered by the primary care team (55 patients). The primary endpoint--the number of patients returning to independent functional status at hospital discharge--was defined as the ability to perform six activities of daily living and the ability to walk independently. Therapists who undertook patient assessments were blinded to treatment assignment. Secondary endpoints included duration of delirium and ventilator-free days during the first 28 days of hospital stay.

The researchers found that the patients who underwent the mobilization protocol were more frequently able to get out of bed, stand, and occasionally walk with assistance during mechanical ventilation. Return to independent functional status at hospital discharge occurred in 29 (59%) patients in the intervention group compared with just 19 (35%) patients in the control group. Patients in the intervention group also had more ventilator-free days during the 28-day follow-up period than did the controls. The researchers also found that overall, patients in the mobilization group experienced less delirium than did their counterparts who did not receive the intervention. The study was published ahead of print on May 13, 2009 in the Lancet.

"The benefits of pairing mobilization and sedative interruption from the inception of critical illnesses are substantial, but the improvements in function are not easily recognizable until about two weeks," said lead author William Schweickert, M.D., an assistant professor of medicine in the pulmonary, allergy, and critical care division at UPenn. "Starting these therapies early can be difficult in the context of ongoing critical illness, yet the data highlights that it can be done safely. We still need to test how this intervention and its findings translate into longer-term survival and better quality of life."

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University of Pennsylvania Medical Center