Mortality in the ICU has dramatically decreased over the past decades because of a clearer understanding of disease pathophysiology, improved technology, and novel therapies. This success has led to the new challenge of treating patients with chronic disabilities resulting from prolonged ICU stays. In this review, the authors (a) describe the emerging understanding of the basis for ICU-acquired weakness, including contributing factors such as prolonged bed rest; (b) provide the background for the safety and efficacy of early mobilization; and (c) give practical guidance for the implementation of ICU early mobilization based on their experience over the past 8 years.
StevensRDDowdyDWMichaelsRKMendez-TellezPAProvonostPJNeedhamDM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007;33:1876-1891.
2.
TanseyCMLouieMLoebM. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167:1312-1320.
3.
Van Den BergheG. How does blood glucose control with insulin save lives in intensive care?J Clin Invest. 2004;114:1187-1195.
4.
BoltonCF. Neuromuscular manifestations of critical illness. Muscle Nerve. 2005;32:140-163.
5.
Van Den BergheGSchoonheydtKBecxPBruyninckxFWoultersPJ. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64:1348-1353.
6.
RossignolBGueretGPennecJP. Effects of chronic sepsis on the voltage-gated sodium channel in isolated rat muscle fibers. Crit Care Med. 2007;35:351-357.
7.
FriedrichOHundEWeberCHackeWFinkRH. Critical illness myopathy serum fractions affect membrane excitability and intracellular calcium release in a mammalian skeletal muscle. J Neurol. 2004;251:53-65.
8.
HermansGDe JongheBBruyninckxFVan Den BergheG. Clinical review: critical illness polyneuropathy and myopathy. Crit Care. 2008;12:238.
SteinTPWadeCE. Metabolic consequences of muscle disuse atrophy. J Nutr. 2005;135:1824S-1828S.
11.
TruongADFanEBrowerRGNeedhamDM. Bench-to-bedside review: mobilizing patients in the intensive care unit—from pathophysiology to clinical trials. Crit Care. 2009;13:216-223.
12.
Gomez-CabreraMCBorrasCPallardòFVSastreJJiLLVinaJ. Decreasing xanthine oxidase-mediated oxidative stress prevents useful cellular adaptations to exercise in rats. J Physiol. 2005;567:113-120.
13.
PetersenAMPedersenBK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98:1154-1162.
14.
MorrisPEGoadAThompsonC. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238-2243.
15.
NeedhamDMWangWDesaiSV. Intensive care unit exposures for long-term outcomes research: development and description of exposures for 150 patients with acute lung injury. J Crit Care. 2007;22:275-284.
16.
RochesterCL. Rehabilitation in the intensive care unit. Semin Respir Crit Care Med. 2009;30:656-669.
17.
WinkelmanCHigginsPAChenY-JK. Activity in the chronically ill. Dimens Crit Care Nurs. 2005;24:281-290.
18.
HodgkinKENordon-CraftAMcFannKKMealerMLMossM. Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med. 2009;37:561-566.
19.
BaileyPThomsenGESpuhlerVJ. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139-145.
20.
ThomsenGESnowGIRodriguezLHopkinsRO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36:1119-1124.
21.
StillerKPhilipsACLambertP. The safety of mobilization and its effect on hemodynamic and respiratory status of intensive care patients. Physiother Theory Pract. 2004;20:175-185.
22.
SchweickertWDPohlmanMCPohlmanAS. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized, controlled trial. Lancet. 2009;373:1874-1882.
23.
ZanottiEFelicettiGMainiMFracchiaC. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124:292-296.
24.
TorkingtonMMacRaeMIslesC. Update of and adherence to exercise during hospital hemodialysis. Physiotherapy. 2006;92:83-87.
25.
GaletkeWRanderathWPfeifferMFeldmeyerFRühleKH. Spiroergometry in patients with severe chronic obstructive disease confined to bed [in German]. Pneumologie. 2002;56:98-102.
26.
NeedhamDMTruongADFanE. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009;37(10 suppl):S436-S441.
27.
StillerK. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007;23:35-53.
28.
MorrisPEHerridgeMS. Early intensive care unit mobility: future directions. Crit Care Clin. 2007;23:97-110.
