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

Early mobilization in the intensive care unit (ICU) is currently a hot topic, with more than 15 randomized controlled trials (RCTs) in the past ten years including several high impact publications [1]. However, the largest studies of early mobilization have enrolled 300 patients, and the results of phase II randomized trials, pilot studies and observational studies have been used to encourage practice change [2, 3, 4, 5]. There are currently several international practice guidelines available, and early mobilization 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. The reported benefits of early mobilization, include reduced ICU‐acquired weakness, improved functional recovery within hospital, improved walking distance at hospital discharge and reduced hospital length of stay [1]. However, medical research has repeatedly demonstrated that the results of pilot studies and phase II studies may 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, with several randomized trials delivering significantly less early mobilization than specified in the study protocol [2, 9] and observational studies reporting very low rates of early mobilization during the ICU stay [10, 11].

This chapter summarizes the considerations for patient safety during early mobilization; including the physiological assessment of the patient, the consideration of invasive lines and monitoring, the management of sedation, strategies to educate and manage the multidisciplinary team and environmental factors. Importantly, we will consider the long‐term effect of early mobilization on patient outcome and the future directions for this important area of work for ICU clinicians.