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ventilation for longer than 7 days, the incidence of icuacquired(neuromuscular) weakness is reported to bebetween 25 and 60% (table 1) [1,7,8]. such weakness maycontribute to increased duration of mechanicalventilation, increased length of stay in the icu andhospital, and poor quality of life among survivors [9-11].th ese data suggest that any interventions which mayattenuate such weakness and/or shorten the duration ofrecovery have the potential to improve both the quality oflife of patients and reduce healthcare costs. earlymobilization (em) may represent one such intervention.in general terms, em of icu patients includes theapplication of traditional modes of physical therapy at anearlier stage than and delivered more regularly thanconventional practice, and/or the early use of novelmobilization techniques (for example, cycle ergometry,transcutaneous electrical muscle stimulation). em appearsphysiologically logical in patients who would otherwiseremain almost immobile, and may also be a safe andfeasible process. more importantly, em may also improvefunctional recovery, reduce the icu length of stay,decrease readmissions to the icu and even improvesurvival [12-16]. yet limited systematic attention andanalysis has so far been applied to the understanding andassessment of em [17]. in this article we aim to defi ne theconcept of em in comparison with traditional physicaltherapy, to review the evidence for its feasibility, safetyand possible effi cacy, and to defi ne the research agendafor its more comprehensive assessment.traditional physical therapyth ere are international guidelines on the traditionalapproach to physical therapy for patients in the icu.th ey include the application of a passive range ofmovements and the encouragement of an active range ofmovements early in the icu stay [18]. attempts at fullactive mobilization are often reserved until after theacute phase of the illness has resolved. in particular, it isrecognized that rehabilitation may not commence untilafter icu discharge, as the patients are viewed as too sickto participate whilst receiving mechanical ventilation.th ese traditional practices are not based on high-qualityevidence and are simply derived from expert opinion.despite such opinions, however, practice and attitudessurrounding physical therapy and mobilization in theabstractearly mobilization (em) of icu patients is aphysiologically logical intervention to attenuate criticalillness-associated muscle weakness. however, itslong-term value remains controversial. we performeda detailed analytical review of the literature usingmultiple relevant key terms in order to provide acomprehensive assessment of current knowledgeon em in critically ill patients. we found that the termem remains undefi ned and encompasses a range ofheterogeneous interventions that have been usedalone or in combination. nonetheless, several studiessuggest that diff erent forms of em may be both safeand feasible in icu patients, including those receivingmechanical ventilation. unfortunately, these studiesof em are mostly single center in design, have limitedexternal validity and have highly variable controltreatments. in addition, new technology to facilitateem such as cycle ergometry, transcutaneous electricalmuscle stimulation and video therapy are increasinglybeing used to achieve such em despite limitedevidence of effi cacy. we conclude that althoughpreliminary low-level evidence suggests that em in theicu is safe, feasible and may yield clinical benefi ts, emis also labor-intensive and requires appropriate staffi ngmodels and equipment. more research is thus requiredto identify current standard practice, optimal emtechniques and appropriate outcome measures beforeem can be introduced into the routine care of criticallyill patients.© 2010 biomed central ltdclinical review: early patient mobilization in the icucarol l hodgson*1,2, sue berney3,4, megan harrold5,6, manoj saxena7,8,9 and rinaldo bellomo1review*correspondence: carol.hodgson@monash.edu1australia and new zealand intensive care research centre, school of publichealth & preventive medicine, monash university, the alfred centre, 99commercial road, melbourne, vic 3004, australiafull list of author information is available at the end of the article
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