The Effectiveness of Early Mobilisation in Critically ill Patients

Abstract

Purpose: The purpose of this review is to evaluate the application of early mobilisation in critical care settings and to weigh the advantages and disadvantages of this intervention. This assessment is done in order to improve the standards of care for critically ill patients. Methods: PICO framework (Population, Intervention, Comparison, and Outcome) was used to inform the research question. Online databases including Embase, Cochrane, and PubMed were used for the search strategy. 4102 initial results were generated. 20 records were removed as duplicates present in the results. The remaining studies were screened. 4046 records were removed. After detailed assessment of the remaining 36, 11 randomised controlled trials were selected for this systematic review. Quality appraisal and assessment for bias were carried out fully. Results: All 11 studies had the same nature, they were randomised controlled trials. Most of the studies were multi centre and involved multiple countries and continents. Most involved the general intensive care unit (ICU), but all types of ICU, including medical, surgical, and emergency had their patients involved in this study. The intervention studied was early mobilisation. There were four exceptions in which an adjunctive therapy was also included as intervention in the study, including electrical stimulation of the muscles, nutrition therapy, and resistance training. The primary outcome and the secondary outcome were decided in advance and then assessed. The review of these studies showed that there is an increase in functional independence in patients receiving early mobilisation in comparison with the control groups. Moreover, the length of ICU stay was decreased in the patients belonging to the intervention group. The reports on adverse events show that their occurrence in a serious setting is rare. On the occasion that they do occur, there is no direct association with the intervention of mobilisation. A decrease in delirium associated with ICU stay has been reported as well. There were also conflicting reports regarding the duration of mechanical ventilation in comparison with the control group. The results on the improvement of the quality of life are not sufficient to warrant a definitive conclusion. Lastly, this intervention has been found to be feasible and easily applicable for both healthcare professionals and patients. Long-term mortality has not been well studied. This is because of the attrition bias as well as different times of follow up. Conclusion: Patients suffering from critical illness, especially in the ICU settings, are prone to a myriad of compilations. Early mobilisation is a safe and feasible technique that can be incorporated into the standard care of critically ill patients. It has been found to improve functional status of the patient while decreasing the length of stay in the ICU. Moreover, it reduces the duration of delirium and is not associated with any serious adverse events. Its effects on the quality of life, length of stay in the hospital, and mortality are yet to be studied.