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Recent evidence on early mobilization in critical-Ill patients

Fuest, Kristina; Schaller, Stefan, J.

Current Opinion in Anaesthesiology: April 2018 - Volume 31 - Issue 2 - p 144–150
doi: 10.1097/ACO.0000000000000568
INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski
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Purpose of review To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field.

Recent findings Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsistent (e.g. stroke). Successful implementation of early mobilization requires a cultural change; preferably based on an interprofessional approach with clearly defined responsibilities and including a mobilization scoring system. Although the evidence for the majority of the technical tools is still limited, the use of a bed cycle ergometer and a treadmill with strap system has been promising in smaller trials.

Summary Early mobilization is well tolerated and feasible, resulting in improved outcomes in surgical and medical ICU patients. Implementation of early mobilization can be challenging and may need a cultural change anchored in an interprofessional approach and integrated in a patient-centered bundle. Scoring systems should be integrated to define daily goals and used to verify patients’ achievements or identify barriers immediately.

Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

Correspondence to Dr Stefan J. Schaller, MD, MHBA, Klinik für Anaesthesiologie, Klinikum rechts der Isar der TUM, Ismaningerstr, 22, 81675 Munich, Germany. Tel: +49 89 4140 9635; e-mail: s.schaller@tum.de

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