Safety and early mobilization in intensive care unit patients: An updated systematic review and meta-analysis of...

Prolonged immobility during intensive care unit (ICU) admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times. Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.

To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.

A systematic search was performed through MEDLINE, Scopus, and Cochrane Library from inception until September 2024 for randomized controlled trials (RCTs) comparing early mobilization (EM) with usual or conventional care in critically ill adult patients. Primary outcomes included length of ICU (days) and ventilation duration (days). Secondary outcomes included muscle strength, functional status, adverse events, all-cause mortality, and quality of life (QOL). A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios (RR) and corresponding 95% confidence intervals (CI).

Out of 3487 results, 16 RCTs were included with a population of 2385 patients (1195 receiving EM and 1190 with usual care.) A significant reduction in the length of ICU stays [mean difference (MD) = -1.02, 95%CI: -1.96 to -0.09; P = 0.03; I ² = 60%] and ventilation duration (MD = -1.07, 95%CI: -1.91 to -0.23, P = 0.01; I ² = 57%) was observed in the EM group compared to usual care. EM significantly improved muscle strength [standard MD (SMD) = 0.47, 95%CI: 0.18-0.75, P = 0.001; I ² = 79%] and functional status (SMD = 0.70, 95%CI: 0.40-1.00, P < 0.00001; I ² = 81%) in ICU patients. No statistically significant difference was observed in adverse events (RR = 1.72, 95%CI: 1.01-2.94, P = 0.05; I ² = 31%), all-cause mortality (RR = 1.10, 95%CI: 0.79-1.53, P = 0.57; I ² = 30%), and QOL (SMD = 0.04, 95%CI: -0.07-0.15, P = 0.50; I ² = 9%) between the two groups.

Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration. These findings indicate that EM may be a safe option for ICU patients, contributing to lower recovery times and healthcare costs. Further extensive research is required to validate the long-term effects on survival and QOL.