Understanding early goal-directed mobilization in the surgical intensive care unit

As the population ages and the mortality associated with critical illness is decreasing, there is a growing population of intensive care unit (ICU) survivors who frequently experience long-lasting impairments in physical, cognitive and mental health, commonly referred to as the “Post-Intensive Care Syndrome (PICS)” (1). In particular, muscle weakness is common (2-4), and is associated with worse patient outcomes (5-8). Prolonged bedrest can contribute to such “ICU-acquired weakness” (9), and there is a growing body of literature demonstrating that early mobilization and physical rehabilitation in the ICU can improve muscle weakness, physical functioning, and quality of life in ICU survivors (10-14). There are very few studies (11) specifically evaluating early mobilization in surgical intensive care unit (SICU) patients. There are multiple perceived barriers to early mobilization and rehabilitation in the SICU, including concerns related to pain, wound dehiscence, dislodgement of drains and other medical devices, as well as limitations in staffing, time and resources (15). A new, international multi-centered randomized trial (16) evaluating the efficacy and safety of early mobilization and rehabilitation in SICU patients adds to the existing literature supporting this intervention in ICU patients.