Early Mobilization of Critically Ill Patient in Intensive Care Unit Research Question 2022

Running head: MINOR PROJECT 1
The Effectiveness of Early Mobilization of Critically Ill Patient in the Intensive Care Unit: A
rapid Review
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MINOR PROJECT 2
Objectives
The purpose of this rapid review is to examine the effectiveness of early mobilization for
patients in intensive care units using evidence from systematic reviews.
The research question will be:
What is the effectiveness of early mobilization for patients in intensive care units?
Keywords: “mobilization”, “early mobilization”, “physical therapy”, “rehabilitation”, and
“intensive care unit”.
Background
The survival of critically ill patients can be attributed to the care received in the Intensive
care Unit (ICU), however, they are usually affected both physically and emotionally by the
sequelae that may be deteriorated by immobility. Part of the clinical prescription for such
patients is usually immobilization or bed rest because of the medication or mechanical
ventilation (Drolet, et al., 2012). About 20-50% of acute cases undergo intensive care unit-
acquired weakness (ICU-AW) (Puthucheary et al., 2013; Denehy, Lanphere, & Needham, 2017).
ICU-AW consists of multiple complications caused by pharmacological sedation after ICU
admission and is linked to the general health and high death rates after hospital discharge (Jolley,
Bunnell, & Hough, 2016; Fan et al., 2014).
ICU-AW is significantly worsened by along time of total rest due to medication and
motionlessness (Friedrich et al., 2015). It is a routine practice of the use of movement approaches
in the ICU as a treatment to avert or reduce immobility and ICU-AW (Li et al., 2013). Studies
have proposed the use of early mobilization as an effective intervention for ICU-AW since it
reduces life-threatening sickness related to muscle wasting (Verceles et al., 2018). Berry and
Morris (2013) conducted a study in 2013 and found out that early exercise was effective in

MINOR PROJECT 3
reducing the period of staying in the hospital and enhance performance among adults with severe
respiratory complications.
Santos et al. (2017) recommended the use of early movement as a potential intervention
in the aversion of postoperative problems, enhanced functionality and minimizing the period of
stay at the hospital length by heart surgey patients. In 2017, Nydahl et al. (2017) observed that
early mobilization and physical functionality for severely sick patients were much safer and had
minimal risk of significant severe effects. Another systematic review was conducted in 2018 16
on the efficiency of early movement on acute patients under mechanical ventilation. The authors
reported that early mobilization among ICU patients produced positive results on hospital results
for patients in need of mechanical ventilation since it has the potential advantage of reducing the
length of mechanical ventilation and the duration in ICU.
However, several reviews of early movement internetion in seriously sick patients have
produced conflicting outcomes. Some of the reviews show varying effects on functional
recovery, duration of ICU, quality of life, or complete stay at the hospital, and long or short-term
death, whereas others completely oppose the existence such benefits (Castro-Avila et al., 2015).
According to Sosnowski et al. (2015), such conflicting outcomes may be attributed to multiple
factors like variation in the intervention, differences in reporting, quality of assessed resources
among others. Most of the qualitative reviews of the existing literature have so far found out that
the existing evidence on the effect of early movements on the physical enhancement of critically
ill patients is inadequate (Doiron, Hoffmann, & Beller, 2018).
Additionally, it is important to observe that some qualitative reviews have completely
considered the existing evidence as inadequate for comparison citing the inconsistency or
reliability of the intervention. For instance, Reid et al. (2018) reviewed 117 studies and found out

MINOR PROJECT 4
that none of them reported the same intervention precisely the same way. 37% of the studies did
not indicate the time the intervention began and 26% did not indicate the duration the
intervention took, thus limiting the comprehension and generalizability of the interventions. A
meta-analysis carried out in 2015 by Castro-Avila et al. (2015) contended that early mobilization
in the duration of ICU is not linked to enhanced functionality, quality of life, muscle strength, or
the optimization of healthcare outcomes.
Another qualitative review conducted in 2016 by Laurent et al. (2016) proposed that early
physical activity in the ICU is reasonable and safe, however the significant advantages of
initiating an early program has not been evidently proven by research. Mixed outcomes on the
impact of early mobilization on physical function were reported in 2018 in the study by Doiron,
Hoffmann, and Beller (2018). The authors explained the challenges in ascertaining whether early
mobilization or physical activity carried out by seriously sick patients in the ICU enhanced their
capacity to undertake routine activities, better quality of life and muscle strength.
Furthermore, the latest Pain, Agitation/Sedation, Delirium, Immobility, and Sleep
Disruption (PADIS) guideline (2018) proposes that early movement can safely be introduced in
seriously sick adults on condition that their cardiovascular, neurological, and respiratory
conditions are stable) Devlin et al., 2018). Additionally, there has been the publication of latest
studies examining the effect of early movement in the ICU settings. Therefore, there should be a
re-examination of the effect of early mobilization on critically ill patients in the ICU. It is on this
basis that the current rapid review is aimed at expansively assessing the existing evidence on the
effect of early mobilization on critically ill patients in the ICU.
Inclusion Criteria
Types of studies