Critical Care Medicine

Sedative and analgesic medications used for mechanically ventilated (MV) patients in intensive care units (ICU) can promote adverse consequences, including prolonged MV and ICU length of stay, ventilator-acquired pneumonia, and ICU-related delirium. Various strategies to minimize these effects have been examined including sedation-based analgesia and daily interruption of sedation. Physical mobilization may also reduce the occurrence of MV-associated adverse consequences. This randomized controlled study examined the effects of early physical mobilization on patients in the ICU and the number of patients returning to independent functional status (the ability to perform six activities of daily living and to walk independently) at hospital discharge. Duration of delirium and ventilator-free days were also measured. Adult patients admitted in two ICUs with MV for less than 72 h were randomly assigned to early exercise and mobilization (intervention group, n 49) or standard care (control group, n 54). Both groups underwent daily interruption of sedation and repeated spontaneous breathing trials. Physical mobilization included incremental range of motion exercises, and progressive therapy continued on a daily basis throughout the patient’s hospital stay. The assessment by physical therapy at the conclusion, six activities of daily living (e.g., eating, bathing, walking), was blinded to mobilization or standard care assignment. Before admission, patients had functional independence (Barthel index score 85–100) and a moderate severity of illness (Acute Physiology and Chronic Health Enquiry II score 13–24). Patients in the intervention group underwent physical therapy after intubation, 5.9 days sooner than controls (P 0.001). More patients in the intervention group returned to independent functional status at hospital discharge (59% vs. 35%; P 0.02). Patients in the intervention group had higher Barthel index scores, a greater number of independent activities of daily living, farther unassisted walking distances at hospital discharge, a shorter duration of ICU-related delirium (2.0 days vs. 4.0 days; P 0.02), and more ventilator-free days (23.5 days vs. 21.1 day; P 0.05). Length of stay in ICU and hospital were similar between groups. Desaturation ( 80%) was the only serious adverse event.