From bedside to beyond: The long-term impact of early mobilization in the ICU

Abstract

Advances in critical care have substantially reduced intensive care unit (ICU) mortality; however, survivors frequently face long-lasting sequelae, including physical disability, cognitive decline, psychological disorders, and impaired health-related quality of life (HRQoL), collectively known as post-intensive care syndrome (PICS). Critical illness weakness (CIW) is a major contributor to the physical dimension of PICS and is associated with adverse short- and long-term outcomes. EM has been proposed as a key non-pharmacological intervention to mitigate CIW, preserve muscle mass and function, and improve patient recovery. Evidence consistently demonstrates that EM is feasible and generally safe in the ICU setting, and that it confers several short-term benefits, including improved functional independence, reduced duration of delirium, and fewer complications such as ventilator-associated pneumonia and venous thromboembolism. However, the impact of EM on long-term outcomes remains uncertain. Meta-analyses and smaller trials suggest that EM may improve patient-reported physical function at 6 months, but large randomized controlled trials and longer follow-up studies have not shown sustained improvements in objective measures of physical performance, cognitive outcomes, or HRQoL. Several factors may account for these discrepancies, including heterogeneity of mobilization protocols, variations in patient selection, limited continuation of rehabilitation after ICU discharge, and the complex multifactorial nature of long-term impairments. Integration of EM with optimal nutrition and multimodal rehabilitation strategies may hold greater promise, but robust evidence is lacking. Overall, while EM remains a cornerstone of ICU rehabilitation with clear short-term benefits, its long-term impact is less certain, underscoring the need for further high-quality, patient-centered research.