- Letter to the Editor
- Open Access
Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019)
Journal of Intensive Care volume 8, Article number: 21 (2020)
Critical comment on the review by Okada et al. on the effect of early versus delayed mobilization because of their definition of early mobilization as mobilization within a week of ICU admission in contrast to current evidence.
In their systematic review and meta-analysis, Okada et al. investigate the impact of early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients, including 11 studies in their meta-analysis . They compared randomized controlled trials (RCTs) starting mobilization within 1 week of ICU admission to those initiating mobilization later than 1 week.
Aware that there is no uniform definition of “early mobilization” in the ICU yet, to use 1 week as cut-off point seems unreasonable for various reasons. So far, only studies starting early mobilization within 72 h have been able to improve patient outcomes, as summarized in published narrative reviews  with adoption in practice guidelines . Schweickert et al. applied physical therapy and interruption of sedation within 72 h of ICU admission causing higher independent functionality at hospital discharge, shorter duration of delirium, and more ventilator-free days . In another single-center RCT, the effect of standardized rehabilitation therapy in patients with acute respiratory failure leads to functional results at 6 months after hospital discharge . . And the just published study of an early mobility program started within 48 h confirmed improvement in function and increased functional independence . In contrast, studies starting mobilization later had no beneficial effect .
Another current meta-analysis using different definitions was able to show an effect of early mobilization . Finally, Ding et al. showed in their network meta-analysis that initiation of mobilization within 48–72 h in mechanical ventilation patients may be optimal to improve intensive care unit-acquired weakness .
In conclusion, as timing seems crucial for patient-centered outcomes, early mobilization should be consistently defined as mobilization within 72 h of ICU admission.
Availability of data and materials
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Kuhn, K.F., Schaller, S.J. Comment on Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis (Okada et al., Journal of Intensive Care 2019). j intensive care 8, 21 (2020). https://doi.org/10.1186/s40560-020-0436-7
- Critical illness
- Early mobilization