Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care

Creating a Standard of Care

Christiane Perme, PT, CCS; Rohini Chandrashekar, PT, MS, CCS


Am J Crit Care. 2009;18(3):212-221. 

In This Article

Abstract and Introduction


New technologies in critical care and mechanical ventilation have led to long-term survival of critically ill patients. An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients who are receiving mechanical ventilation. Prolonged stays in the intensive care unit and mechanical ventilation are associated with functional decline and increased morbidity, mortality, cost of care, and length of hospital stay. Implementation of an early mobility and walking program could have a beneficial effect on all of these factors. The program encompasses progressive mobilization and walking, with the progression based on a patient's functional capability and ability to tolerate the prescribed activity. The program is divided into 4 phases. Each phase includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase are provided. Use of this program demands a collaborative effort among members of the multidisciplinary team in order to coordinate care for and provide safe mobilization of patients in the intensive care unit.


New technologies in critical care and mechanical ventilation have led to longterm survival of critically ill patients and a dramatic increase in the number of ventilator-dependent patients. Each year, more than 1 million patients who require mechanical ventilation are admitted to intensive care units (ICUs) in the United States.[1] In addition to their comorbid diseases, patients who require mechanical ventilation have many barriers to mobility. They are surrounded by catheters, tubes, and life support and monitoring equipment. Mobilization is perceived as a complex task, and therefore these patients are often treated with bed rest. After 1 week of bed rest, muscle strength may decrease as much as 20%, with an additional 20% loss of remaining strength each subsequent week. Weakened muscles generate an increased oxygen demand.[2] This weakness presents challenges to weaning from ventilatory support. Bed rest and inactivity are among the contributing risk factors for ICU-acquired neuromuscular weakness, and a strong correlation between this type of weakness and prolonged mechanical ventilation has been observed.[3] Both respiratory and limb muscle strength are altered after 1 week of mechanical ventilation, and respiratory muscle weakness is associated with delayed extubation and prolonged ventilatory support.[4]


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