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.
From Bedrest to Better: Why Mobilise in ICU?
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.
Proof in Practice: The First Mobilisation Trials
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.
Key Takeaways
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.