Early Mobilization in the ICU: Could It Be the Key to Better Outcomes for Mechanically Ventilated Patients? A Systematic Review

Abstract

Background: The early mobilization and rehabilitation of critically ill patients have garnered significant attention in recent years, driven by the growing awareness of the neuromuscular impairments and physical dysfunctions that often arise as a consequence of prolonged critical illness. This systematic review was conducted to explore and assess the impact of early mobilization on several key outcomes for these patients, including the incidence of ICU-acquired weakness, mortality rates, the duration of mechanical ventilation, the length of ICU stay, and overall functional recovery. Methods: A comprehensive literature search was conducted across PubMed, Cochrane, and the Physiotherapy Evidence Database (PEDro) using a structured PICOS framework. The inclusion criteria focused on randomized controlled trials (RCTs) comparing early mobilization interventions with standard care in adult ICU patients requiring mechanical ventilation. Relevant data were manually extracted from each included study and subsequently processed for further analysis. The selected studies were critically appraised using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: This review incorporated eight randomized controlled trials (RCTs) involving a total of 1,914 patients. The findings suggest that early mobilization does not significantly impact mortality rates or the number of ventilator-free days. However, there were mixed results regarding ICU-acquired weakness, duration of mechanical ventilation, ICU length of stay, and functional recovery. Notably, some studies reported improvements in functional outcomes and reduced ICU stay durations in patients receiving early mobilization, though these findings were not consistent across all trials. Conclusion: The overall trend observed across the included studies indicates no significant effect of early mobilization on mortality rates or ventilator-related outcomes. The results are mixed regarding its impact on ICU-acquired weakness, duration of mechanical ventilation, ICU length of stay, and functional recovery. These findings suggest that while early mobilization shows potential benefits in certain areas, its overall effectiveness remains uncertain, highlighting the need for further research and the development of standardized protocols to fully understand its impact.