Feature

Early Mobility in the

Intensive Care Unit:
Evidence, Barriers, and
Future Directions
Susan M. Dirkes, MS, RN, CCRN
Charles Kozlowski, RN

Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free
days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can
prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease
length of stay in a rehabilitation facility. Yet many barriers exist to implementing early mobility effec-
tively, including patient acuity, uncertainty about when to start mobilizing the patient, staffing and
equipment needs, increased costs, and limited nursing time. Implementation of early mobility requires
interdisciplinary collaboration, commitment, and tools that facilitate mobility and prevent injury to nurses.
This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reduc-
ing sedation, monitoring the patient’s ability to wean from the ventilator, and encouraging early mobility.
It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome
them. (Critical Care Nurse. 2019;39[3]:33-43)

A
s the population ages and new treatments emerge, with more people surviving their illnesses,
increasing numbers of patients are being admitted to critical care units. Today’s critical care
nurses are tasked with all aspects of patient care and implementation of practices to improve
outcomes. This article focuses on aspects of care that can affect patient outcomes, such as preventing
delirium, reducing sedation, monitoring the patient’s ability to wean from the ventilator, and encourag-
ing early mobility. It also addresses the effects of immobility, as well as challenges in achieving mobility
and tools now available to help overcome them.
The Society of Critical Care Medicine’s recently released “Clinical Practice Guidelines for the Manage-
ment of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit” brings together current
evidence on optimal management of pain, agitation, sedation, and delirium.1 The framework to facilitate
implementation of these guidelines is an extensive set of evidence-based recommendations addressing
key elements of health care quality and safety and patient suffering during critical illness.2 The ABCDEF

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 bundle represents Assess, prevent and manage pain; Patients admitted to ICUs today are often older than
Both spontaneous awakening trials and spontaneous in the past, and survival of illness has improved markedly
breathing trials; Choice of sedation and analgesia; Delir- in recent years.10-14 Improving mobility follows reducing
ium: assess, prevent and manage; Early mobility and sedation in a natural sequence: increasing patient activ-
exercise; and Family engagement and empowerment.3 A ity requires patients to be alert and interactive rather
bundle is a structured way of improving the processes of than sedated. Adherence to the ABCDEF bundle can be
care and patient outcomes: a small, straightforward set helpful in facilitating this transition. Barriers to mobility
of evidence- based practices—generally 3 to 5—that, implementation include patients’ being deemed “too
when performed collectively and reliably, have been sick” to engage in physical activity and the presence of
shown to improve patient outcomes.4 many tubes and catheters, as well as intervention-related
Health care organizations that implement the ABCDEF issues, communication and care coordination challenges,
bundle have improved patient outcomes such as reduced knowledge deficits, workload concerns, and documenta-
intensive care unit (ICU) and hospital lengths of stay, tion burdens.8,15-17 In one international survey, safety
shortened duration of mechanical ventilation, decreased concerns were considered a significant barrier to early
prevalence and duration of delirium, and decreased mobility.18 Improving mobility may be the most chal-
health care costs.5,6 This bundle can be implemented in lenging part of rethinking critical care, as it involves
today’s ICUs by, for example, waking patients each day the greatest shift in culture and daily processes.19-21 In
from sedation, monitoring their breathing and assessing addition, implementing a mobility program requires
for readiness to wean from the ventilator, assessing daily continued commitment from all disciplines.
for delirium, and coordinating care between disciplines. Bed rest, or acute inactivity associated with hospital-
The “early mobility” part of the bundle may not be so ization or disease state, poses a potent threat to muscle
easily achieved, for many reasons. According to Balas et tissue and functional capacity. Immobility, even among
al,7 there is little patients who were ambulatory before their illness, is
Improving mobility follows reducing evidence that common during hospitalization. In older adults, physi-
sedation in a natural sequence: mobility inter- cal inactivity during hospitalization is almost an accepted
increasing patient activity requires ventions are part of the inpatient experience yet contributes to a host
patients to be alert and interactive routinely used of negative outcomes, including a reduced ability to per-
rather than sedated. in critical care. form activities of daily living, an increased incidence of
They suggest readmission, and institutionalization.22 Early mobility is
that this discrepancy between what is known and what is especially important for the successful transition from the
actually done is due to a knowledge translation gap. Jolley hospital to home. Several trials have established the pos-
et al8 reported that only 8% of German patients receiv- itive effects of early mobilization in critically ill patients,
ing mechanical ventilation received out-of-bed mobiliza- including a significant reduction in the incidence of
tion, and across Australian and New Zealand hospitals delirium and an increase in ventilator-free days.8,20,21,23-25
only 3% achieved sitting at the side of the bed, with none
progressing to standing or walking. The studies that have Effects of Immobility
been conducted have been hampered by a lack of data Lack of physical activity and prolonged bed rest have
identifying at-risk groups, problems with identifying the significant effects on musculoskeletal, cardiovascular,
“chronically critically ill,” and differing lengths of stay.9 respiratory, integumentary, and cognitive systems.20,26-28
In addition, hospitalized patients are often older, and
Authors many are obese. These patient characteristics increase
Susan M. Dirkes and Charles Kozlowski are staff nurses at the Uni- the challenges associated with mobilization.
versity of Michigan hospital, Ann Arbor, Michigan.
Corresponding author: Susan M. Dirkes, MS, RN, CCRN, 3443 Tallywood Circle, Sara- Musculoskeletal Consequences
sota, FL 34237 (email: [email protected]). Studies have shown that skeletal muscle strength
To purchase electronic or print reprints, contact the American Association of Critical- declines by 1% to 1.5% per day when strict bed rest
Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or
(949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected]. begins.29,30 Over time, the loss of lean tissue contributes

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to a decrease in muscle strength and power, which can general care. These and other studies indicate that it is
affect balance and increase the occurrence of falls while essential to take measures to increase mobility in criti-
reducing aerobic capacity.21,28,31-33 Other effects of immo- cally ill patients (Table).
bility include more bony resorption than formation,
resulting in a net reduction in bone integrity and demin- Cardiovascular Consequences
eralization that may place an individual at higher risk of In addition to loss of muscle mass, immobility results
fractures.34 Neuromuscular abnormalities can be found in significant changes in the cardiovascular system. The
in patients with ICU stays of as few as 10 days.34 act of lying down shifts 11% of the total blood volume
Contributors to muscle loss include atrophy from away from the legs, with most of it going to the chest.60
lack of use, inflammation, nutritional deficiencies, and This shift leads to an increase in cardiac workload, ele-
a reduction in muscle protein synthesis.35-39 In addition, vation of resting heart rate, and a decrease in the heart’s
older age, female sex, hyperglycemia, hypoalbuminemia, ability to pump, resulting in a reduction of cardiac out-
parenteral nutrition, corticosteroid administration, and put.61,62 During bed rest, the pulse rate can speed up 1
use of neuromuscular blocking agents are considered pos- beat every few days. Increased heart rate leads to decreased
sible risk factors for ICU-acquired weakness.35,40-46 diastolic filling time and shortened systolic ejection time,
A catabolic state develops rapidly in critically ill making the heart less capable of responding to meta-
patients, particularly those with sepsis.46,47 Immobility bolic demands.63 Stroke volume has been shown to be
increases the production of proinflammatory cytokines reduced by 30% within the first month of bed rest, with
and reactive oxygen species, with subsequent muscle an associated increase in heart rate.64,65 Also, orthostatic
proteolysis promoting overall muscle loss.36,38,48 Anti- tolerance deteriorates rapidly with immobility owing to
gravity muscles such as leg extensors and trunk muscula- baroreceptor dysfunction.24
ture are preferentially affected by the loss of mechanical
loading compared with upper-body musculature.30,36,44,49,50 Respiratory Consequences
As a result of loss of muscle mass, up to 40% of muscle Mechanical ventilation affects the diaphragm and its
strength can be lost within the first week of immobiliza- strength. Clinically important muscle weakness has been
tion.40 In one study involving healthy volunteers, 28 days reported in 25% to 65% of patients receiving mechanical
of bed rest resulted in a 0.4-kg loss of lean muscle leg ventilation for at least 5 days, resulting in a longer dura-
mass and a 23% reduction in leg extension.37 Given that tion of mechanical ventilation and increased ICU length
ICU patients are not healthy and are often older than of stay.33,40,66 One study showed that patients with respi-
those in that study, their rate of muscle mass loss may be ratory failure who underwent prolonged mechanical
greater. This muscle weakness and physical disability are ventilation (mean duration, 21 days) had prolonged
commonly found in these patients at discharge and can functional
persist for years after discharge, depending on a variety limitations Nurses must assess whether patients are
of factors.16,31 after hospi- alert and able to be mobilized, as well as
Aging itself also appears to exacerbate inactivity- tal dis- any functional decline, especially if they
mediated muscle loss.51-53 Elderly patients already have charge. 67,68
have been bedridden for several days.
significantly diminished skeletal muscle mass and In another
strength due to sarcopenia.52-56 Kortebein et al35 showed study, although lung volumes improved at 6 months,
that older adults on bed rest had greater muscle losses only 38% of patients had returned to work in their previ-
than did their younger counterparts. If it is assumed ous role, and only 32% had returned in their previous
that the rate of muscle loss is consistent during the role and hours.69
period of bed rest, bedridden older adults would lose The diaphragmatic dysfunction itself originates at
muscle mass at a higher rate. the level of the muscle cell membrane and/or its ability
Over the past 2 decades, improvements in survival to contract.65,66 Demoule et al70 found that patients showed
after discharge from the ICU have probably led to increased a rapid progression of diaphragm atrophy, with a signifi-
awareness of ICU-acquired weakness. Patients who sur- cant decrease in thickness after just 1 day of receiving
vive may be transferred in a very deconditioned state to mechanical ventilation. Dinglas et al71 found that survivors

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 Table Summary of key studies on mobility and findings
Study Design Patients Intervention Primary endpoint Findings
Schweickert Randomized 104 sedated patients Early exercise and mobilization 6-min walk Bedside ergonomics
et al16 controlled in the medical ICU; starting with active assisted distance at was associated with a
trial received mechanical ROM exercises, progressing hospital longer 6-min walk
ventilation for < 72 h to bed mobility, transferring, discharge distance and a trend
and were expected ambulating during periods of toward increased
to continue for at daily sedation interruption discharge to home.
least another 24 h No difference in ICU
LOS or hospital LOS.
Morris Prospective 330 medical ICU Mobilization by mobility team Proportion of The mobility protocol
et al58 cohort study patients at a single per mobility protocol, starting patients was associated with
center with acute with passive ROM progressing receiving PT more patients receiving
respiratory failure to active ROM, resistance, in patients at least 1 PT session
requiring sitting and transferring vs surviving to and getting out of bed
mechanical usual care hospital earlier and shorter
ventilation for less discharge ICU and hospital LOS.
than 48 hours
Engel Prospective Patients at 3 large Used the Institute for Healthcare Incidence of Establishing an early
et al59 study at 3 centers, 2 medical Improvement framework of delirium and mobility program
institutions ICUs and 1 mixed Plan-Do-Study-Act. Each ICU and resulted in reduced
medical-surgical institution developed an hospital LOS ICU and hospital LOS
ICU interprofessional team-based and a decrease in
approach to plan, educate, delirium.
and implement the program.
Champions from each
profession were identified
to facilitate changes in
culture and clinical practice.
Barnes-Daly Prospective 6064 medical/ Total and partial ABCDEF Outcomes of Higher bundle
et al3 quality surgical ICU bundle compliance were survival and compliance was
improvement patients at 7 measured daily, accounting delirium- and associated with
study community for total compliance or partial coma-free days improved survival
hospitals, receiving compliance of the bundle after adjusting and more days free
and not receiving for age, of delirium and coma.
mechanical severity of
ventilation, enrolled illness, and
within 1 year presence of
mechanical
ventilation
Needham Prospective 57 medical ICU Multifaceted intervention Rehabilitation The median number
et al60 before/after patients at a single including creation of a multi- treatments, of rehabilitation
study center, receiving disciplinary team; hiring 1 functional treatments per
mechanical full-time PT, 1 full-time OT, mobility, patient increased,
ventilation for 4 1 part-time rehabilitation sedation and the proportion of
days or more assistant; establishing delirium status treatments involving
guidelines for eligibility for sitting or greater
early mobilization and PT/OT mobility increased,
consultation, and using sedation requirement
administration of sedatives decreased, incidence
on an as-needed basis of delirium decreased,
instead of an infusion and ICU and hospital
LOS decreased.
Abbreviations: ICU, intensive care unit; LOS, length of stay; OT, occupational therapy; PT, physical therapy; ROM, range of motion.

of acute respiratory distress syndrome who had received Challenges in Achieving Early Mobility
mechanical ventilation had a decreased 90-day survival Increasing the activity of patients in the hospital set-
when they had post-ICU weakness at discharge. ting presents many challenges. However, these challenges

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should not prevent attempts to implement a mobility Tools like this may be helpful for patient assessment and
program. Major questions about the use of physical may prevent patient harm.
therapy (PT) for these patients include when to start The ICU or nursing unit may or may not have a dedi-
mobilization, who should deliver the therapy, and cated PT. Even if it does, if the unit is large (more than
how long it should be performed and at what inten- 10 beds), the PT may not be able to spend enough time
sity. Schweickert et al15 found that the percentage of evaluating patients and trying to mobilize them. Another
patients walking independently at hospital discharge consideration is whether the unit has ancillary staff to
doubled from 25% to 50% with early mobilization. help nurses mobilize patients. The optimal frequency of
The recommendations of Bassett et al72 were chal- mobility for a patient has not yet been determined. Some
lenging; some teams who attended the educational institutions have successfully implemented mobilization
sessions on mobility wanted to make the suggested assessments and procedures and incorporated them into
changes but were unable to take effective action on routine activities. These centers have committed teams
return to their organizations. for mobilization, including dedicated PTs.78-80 In the United
Mobilizing patient populations has potential hazards, States, PTs are not frequently available in the ICU; in one
one of which is fall risk. Assessing the risk for falls is part international study, only 34% of ICUs reported having a
of The Joint Commission’s National Patient Safety Goals.73 dedicated PT, and only 40% had an early mobility pro-
Frequently, a conflict arises between considering the gram in place.17 It is debatable whether nurses should be
benefits of mobility and the harm posed by immobility considered qualified to judge a patient’s ability to safely
versus the risks to the patient of mobilization. Patient stand or even sit upright without a PT assessment.
safety is often cited as a barrier to implementing an early Studies have shown that it is important to identify
mobility program.73 The nursing assessment may be that barriers at the organizational level to implementing
mobilization of the patient is not a safe option because early mobility protocols. Such protocols require both
of the patient’s weakness, weight, illness severity, dis- institutional and project leadership; additional staffing
comfort, and length of time in bed. Because critically ill and equipment;
patients have poor vascular tone and often are receiving increased physi- Moving the patient from the bed to
pressors, nurses may be reluctant to move them.72,74 cian referrals a chair is considered mobility if he
Reported barriers to mobilization include the pres- for PT closer to or she can stand and bear weight.
ence of an endotracheal tube, receiving mechanical ven- patient ICU
tilation, the dislodgment of tubes such as catheters in admission; and management of patients’ pain, delirium,
continuous renal replacement therapy and extracorpo- tolerance for activity, and safety.74,75 Very little documen-
real membrane oxygenation, and hemodynamic instabil- tation exists in the literature regarding these issues.
ity.75,76 Sedation and hemodynamic changes are given Even if the institution agrees to implement an early
special consideration in the decision of whether to mobility protocol, additional barriers—both perceived
mobilize the patient.24,76,77 Nurses must assess whether and real—may affect change. Identification of barriers
the patient is alert and able to be mobilized, as well as to early mobilization and strategies to overcome these
how much functional decline there may be, especially if problems should be included as part of an early mobili-
the patient has been bedridden for several days or more. zation plan. Some of the drivers of clinical decisions may
If the assessment is inaccurate, both the nurse and the be modifiable with better adherence to sedation and mobi-
patient are at risk for injury. lization protocols, clinical leadership, and increased staff
Protocols for making step-by-step assessments of the resources and training.
patient’s readiness for mobility have been published.78,79
More recently, an international multidisciplinary expert Costs of Mobility
consensus group developed recommendations for con- Starting a mobility protocol has financial implica-
sideration before mobilization of patients in the ICU tions. Nursing costs, in addition to the use of at least 1
during mechanical ventilation.79 This panel developed a ancillary staff member such as a nursing assistant,81 was
traffic light–based grading system for each of the safety an additional 1 hour per patient day of nursing care
criteria to determine the risks and benefits of mobilization. cost—estimated at an average nursing wage of $540 per

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day for the average census of 18 patients. The average
wage of the temporary nursing technician is $234 per
day for the same census level.81 Justifying the costs of
dedicated PT or specialty tools in the ICU is difficult in
light of the small amount of data available.24 Having
dedicated PTs or even occupational therapists (OTs) to
evaluate the patient and work with staff toward mobility
comes with costs.82 It is important that institutional
leaders believe that the positive outcomes justify these
costs. One study by Jolley et al8 showed that dedicated
PT and OT involvement was strongly associated with
mobility in the ICU. Schweickert et al15 found in a ran-
domized, blinded clinical trial that implementation of
PT and early OT resulted in improved physical function
and a reduced duration of delirium for 104 critically ill
patients who were functionally independent at baseline.
Other costs include those of tools to mobilize patients,
such as lift chairs or mechanical lifts (Figure 1). These
tools can help in mobilizing very weak or very large
patients, but not all institutions have them available.
Worker injuries can be costly. According to the most
recent US Bureau of Labor Statistics data, hospital
workers sustain injuries and illnesses at a rate of 6.8
times that of other workers.83 In a large national survey Figure 1 Liko Ceiling Patient Lift with HighBack
drawn from 53 health care systems with roughly 1000 Sling (Hill-Rom Services Inc) used to lift patient
hospitals in all 50 states, patient handling injuries from bed or chair.
accounted for 25% of all workers’ compensation claims. Courtesy Hill-Rom Services Inc; used with permission.

Patient handling costs of $15 600 and wage replacement

accounted for the largest share of this cost.84 mobility. For example, using the high Fowler upright
In a cost-benefit analysis, decreased length of stay, position in bed can help the patient feel more “normal”
decreased rehabilitation needs, and improved func- and also improve ventilation. One recent study showed
tional recovery at discharge can offset the costs of that patients sitting upright had significantly better
mobility.82 The costs of rehabilitation care also pose oxygen saturation than those who were supine.86
potential barriers to survivors’ recovery. Because of Upright positioning has been associated with oxygen-
severe deconditioning, ICU survivors may be unable ation improvement in patients with acute respiratory
to tolerate the requirements of rehabilitation. In one distress syndrome because of increased functional
study, the median cost of follow-up for all inpatient residual capacity of the lungs.87,88 Upright positions
care (eg, hospitalizations, skilled nursing facility, and have also been associated with a decrease in ventilator-
rehabilitation facility) was $16 800, with 81% of that associated pneumonia.89 Most beds have the high
attributable to postdischarge hospitalization.85 Fowler option for providing a good upright position.
Some nursing staff consider simply sitting upright to
Overcoming Barriers and Tools for Mobility constitute mobility, and this position is definitely a
Nurses can lessen the consequences of immobility by start to mobilization. However, the definition of mobile
initiating conversations with hospital administrators, is “capable of moving.”90 Simply positioning a patient
staff members, and representatives of ancillary disci- upright does not seem to meet this definition. More-
plines about the importance of early mobilization. Some over, this position does not increase strength in the legs,
simple everyday tools are already available to foster where the most significant muscle mass loss occurs.36,50

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 A B

Figure 2 VitalGo Total Lift Bed (VitalGo Systems Ltd). (A) 60-degree tilt. (B) Full stand position.
Courtesy of VitalGo Systems Ltd.

If the patient ends up sliding down in the bed and no these tables are not readily available or frequently used
longer is in the upright position, this slumped position in most nursing units and generally require PT supervi-
is even more detrimental to lung function and effective sion.17 In addition, the patient must be transferred to
gas exchange. Moreover, sitting upright involves the use the table, which requires additional personnel, adding
of core muscles but not the antigravity muscles that are to the nursing workload.
significantly affected by immobility. Chairs that stand the patient are also available. They
Moving the patient from the bed to a chair is consid- accomplish the same objectives as the tilt table, and are
ered mobility if he or she can stand and bear weight. excellent at gradually increasing the patient’s weight-
Nurses engage in heavy lifting to move the patient from bearing, but they come with the same workload challenges
the bed to initiate mobilization. More and more hospi- mentioned above. These chairs may not be suitable for
tals are using mechanical lifts to move a patient into a the obese patients frequently encountered in practice.
chair. Patients simply sitting in a chair are generally
not using extensor muscles unless they are using the Newer Tools for Mobility
pedal device or stretch bands, which can greatly improve Newer beds are being devised that can help increase
overall mobility. mobility for normal-weight patients, obese patients, and
Inflatable hover mats are also good tools to move the critically ill. These include typical critical care beds
the patient from the bed to a chair if no lift is available. such as the VitalGo Total Lift Bed (VitalGo Systems Ltd;
Again, however, the patient must perform some type of Figure 2) and the Catalyst bed (Kreg Therapeutics; Figure
exercise to strengthen muscles while in the chair, such 3). These beds are unique in that they can stand patients
as pedaling or using elastic bands. upright. The patient is strapped in at the legs and the
Tilt tables can be used to gradually move the patient chest and the bed is gradually moved into a more upright
into an upright standing position. This tool does improve position. This type of bed accommodates obese patients,
mobility because it not only positions the patient upright requires fewer staff members, and allows gradual and safe
but at the same time improves orthostatic stability. Some positioning of the patient, and thus can greatly improve
of these tables allow the patient to stand on a surface at patient mobilization. Much like the tilt table and stand-
the foot of the table, causing the patient to use the leg ing chair, this type of bed can also help reduce footdrop,
muscles to bear weight. This maneuver not only increases increase leg muscle strength, and improve ventilation and
muscle strength but also improves ventilation.91 However, weaning from supplemental oxygen or the ventilator.

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 See also
To learn more about mobility in the critical care setting, read “Identi-
fying Barriers to Nurse-Facilitated Patient Mobility in the Intensive
Care Unit” by Young et al in the American Journal of Critical Care, May
2018;27:186-193. Available at www.ajcconline.org.

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 CCN Fast Facts CriticalCareNurse
The journal for high acuity, progressive, and critical care nursing

Early Mobility in the Intensive Care Unit:

Evidence, Barriers, and Future Directions

E arly mobility is a high priority to help patients

recover and reduce their length of stay. Current
methods of providing early mobility are time
consuming, are potentially costly if therapists are used,
and typically increase the nursing workload. Having the
start to mobilization. However, the definition of mobile
is “capable of moving.” Simply positioning a patient
upright does not seem to meet this definition. Moreover,
this position does not increase strength in the legs,
where the most significant muscle mass loss occurs.
proper tools can improve outcomes. Nurses play an • Moving the patient from the bed to a chair is considered
important role in driving the change toward early mobility if he or she can stand and bear weight. More
mobilization of critical care patients. and more hospitals are using mechanical lifts to move a
• Bed rest poses a potent threat to muscle tissue and patient into a chair. Inflatable hover mats are also good
functional capacity. Studies have shown that skeletal tools to move the patient from the bed to a chair.
muscle strength declines by 1% to 1.5% per day when • Tilt tables can be used to gradually move the patient
strict bed rest begins. Over time, the loss of lean tis- into an upright standing position. Chairs that stand the
sue contributes to a decrease in muscle strength and patient are also available. They are excellent at gradually
power, which can affect balance and increase the increasing the patient’s weightbearing, but may not be
occurrence of falls while reducing aerobic capacity. suitable for the obese patients frequently encountered
• Immobility also results in significant changes in the in practice.
cardiovascular system. The act of lying down shifts • Newer beds can help increase mobility for normal-
11% of the total blood volume away from the legs, weight and obese critically ill patients. The patient is
with most of it going to the chest. This shift leads to strapped in at the legs and the chest and the bed is
an increase in cardiac workload, elevation of resting gradually moved into a more upright position. This
heart rate, and a decrease in the heart’s ability to type of bed requires fewer staff members and allows
pump, resulting in a reduction of cardiac output. gradual and safe positioning of the patient, and thus
• Patient safety is often cited as a barrier to implement- can greatly improve patient mobilization. Much like
ing an early mobility program. Nurses must assess the tilt table and standing chair, this type of bed can
whether the patient is alert and able to be mobilized, also help reduce footdrop, increase leg muscle strength,
as well as how much functional decline there may be, and improve ventilation and weaning from supplemen-
especially if the patient has been bedridden for several tal oxygen or the ventilator. CCN
days or more. If the assessment is inaccurate, both the
nurse and the patient are at risk for injury.
• Some nursing staff consider simply sitting upright to
constitute mobility, and this position is definitely a

Dirkes SM, Kozlowski C. Early mobility in the intensive care unit: evidence, barriers, and future directions. Critical Care Nurse. 2019;39(3):33-43.

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Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions
Susan M. Dirkes and Charles Kozlowski
Crit Care Nurse 2019;39 33-42 10.4037/ccn2019654
©2019 American Association of Critical-Care Nurses
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