Should we mobilise critically ill patients? A review

Abstract

Background: Neuromuscular weakness, a frequent complication of prolonged bed rest and critical illness, is associated with morbidity and mortality. Mobilisation physiotherapy has widespread application in patients hospitalised with non-critical illness.

Objectives: We reviewed the literature to evaluate the worldwide availability of mobilisation therapy in intensive care units and the role of mobilisation therapy in patients requiring medical or surgical high dependency or intensive care.

Methods: We searched PubMed (1980 to August 2009) using the MeSH terms "physiotherapy" and "intensive care". Additional keyword search terms, "mobilisation", "mobilization", and "fast-track", were used. In addition, we examined reference lists in recent studies and reviews.

Results: Routine mobilisation physiotherapy is least likely to be available in ICUs in the United States. Early mobilisation is appropriate for patients with pulmonary thromboembolic disease, community-acquired pneumonia and in elderly hospitalised patients. Although fast-track cardiac and noncardiac surgery with early ambulation is safe and reduces hospital length of stay, it does not alter postoperative mortality. Up to 25% of patients can be safely mobilised within 72 hours of ICU admission. This therapy may reduce hospital and ICU length of stay, shorten duration of mechanical ventilation, and improve muscle strength and functional independence scores. Pooled data show a nonsignificant mortality benefit in favour of early mobilisation (odds ratio, 0.77; 95% CI, 0.49-1.21).

Conclusions: The data in support of mobilisation therapy for perioperative and critically ill patients, while of a low level of evidence, are substantial. This justifies a paradigm shift in attitudes towards physiotherapy and the prevention of critical illness weakness.