JAMA. 2008 Oct 8;300(14):1685-90.
Needham DM.
Division of Pulmonary and Critical Care Medicine, and Department of Physical
Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland 21205,
USA. dale.needham@jhmi.edu
Early mobilization of patients in the hospital and the intensive care unit has a
strong historical precedent. However, in more recent times, deep sedation and bed
rest have been part of routine medical care for many mechanically ventilated
patients. A growing body of literature demonstrates that survivors of severe
critical illness commonly have significant and prolonged neuromuscular
complications that impair their physical function and quality of life after
hospital discharge. Bed rest, and its associated mechanisms, may play an
important role in the pathogenesis of neuromuscular weakness in critically ill
patients. A new approach for managing mechanically ventilated patients includes
reducing deep sedation and increasing rehabilitation therapy and mobilization
soon after admission to the intensive care unit. Emerging research in this field
provides preliminary evidence supporting the safety, feasibility, and potential
benefits of early mobilization in critical care medicine.