Summary
For much of critical care history, immobility was the norm: patients were sedated, kept still, and "protected." But decades of research have revealed the hidden costs — profound muscle wasting, delirium, and long-term disability.
Jonathan explores how our understanding of mobilisation in ICU has evolved — from the recognition of harm caused by bedrest, to the first landmark studies proving that early movement is both feasible and beneficial.
ICU-acquired weakness: Patients can lose 15–20% of muscle mass within the first week of critical illness.
Long-term outcomes: ARDS survivors tracked for five years showed persistent disability and reduced independence.
Sedation & delirium: Deep sedation increases delirium risk; mobilisation reduces both incidence and duration.
Physiological rationale: Even minimal movement supports cardiovascular tone, respiratory function, circulation, and cognition.
Core message: Bedrest is not neutral — it is actively harmful. Mobilisation offers protection for both brain and body.
Feasibility (Morris et al., 2008): Protocol-led mobilisation cut time to first mobilisation (5 vs 11 days), with no increase in adverse events.
Landmark RCT (Schweickert et al., 2009):
Early PT/OT + daily sedation interruption vs SAT alone.
59% vs 35% regained independence at discharge.
Patients had less delirium and spent fewer days ventilated.
Implementation (Needham et al.): Demonstrated how embedding mobilisation into daily ICU practice improves outcomes and serves as a model for quality improvement.
Core message: Early mobilisation is not only possible — it improves patient-centred outcomes safely.
Bedrest and heavy sedation accelerate weakness, delirium, and disability.
Mobilisation is both biologically plausible and clinically effective.
Early trials proved feasibility, safety, and functional benefits.
Success requires:
Lighter sedation targets and daily SATs.
Interdisciplinary teamwork (nursing, PT/OT, medical).
Structured protocols and safety screens.
Overall message: Mobilisation should no longer be an afterthought in ICU. It is a therapeutic intervention — one that supports recovery, preserves dignity, and helps patients walk out of intensive care with more than just survival.
