Safety and Barriers to Care

Critically ill patients are often immobilized as a direct result of their illness or because of the administration of sedatives and analgesics or anesthetic agents that allow patients to receive other supportive care such as mechanical ventilation. Complications of critical illness documented in the literature include pressure ulcers, delirium,^1,2 weakness, critical illness polyneuromyopathy,^3,4 contractures,⁵ and decreased quality of life after hospital discharge.⁶ Moreover, critical illness polyneuromyopathy has significantly associated morbidity and increased hospital mortality.⁴ Several reports^1,7 –11 have now described the safety of organized early mobility therapy in the intensive care unit (ICU). These reports also suggest that improvements in activities of daily living and hospital length of stay were associated with the use of early mobility protocols in the ICU.

Questions often arise about the feasibility of early mobility in the ICU given the frequent need...