COMMENTARY

Does Early Mobilization Reduce Time in the Surgical ICU?

Albert B. Lowenfels, MD

Disclosures

November 23, 2016

Early, Goal-Directed Mobilisation in the Surgical Intensive Care Unit: A Randomised Controlled Trial

Schaller SJ, Anstey M, Blobner M, et al; International Early SOMS-guided Mobilization Research Initiative
Lancet. 2016;388:1377-1388

Summary

Is early mobilization in the surgical intensive care unit (ICU) beneficial? To test this hypothesis, the authors carried out a multicenter, randomized, controlled trial in five university hospitals, where they recruited a total of 200 patients. Abdominal surgery (25%), trauma (20%) and vascular surgery (18%) were the largest groups of patients.

Both study groups received the same level of standard ICU care, with the only difference being that the intervention group participated in a supervised mobilization program. Mobilization scores were higher in this group, and their ICU length of stay was 3 days shorter (P = .0054). These patients were significantly more mobile upon discharge from the ICU (P < .0001). In-hospital mortality did not significantly differ between the groups (P = .09), nor was there any change in 3-month postdischarge mortality (P = .35). Significantly more patients in the enhanced mobilization group were discharged to their home (P = .0007).

Viewpoint

This study demonstrated a gratifying reduction in ICU length of stay and a greater likelihood of patients being discharged to their home. Efforts to increase early mobilization have not been routinely applied to surgical ICU patients, perhaps because of lack of convincing evidence, the possibility of deleterious outcomes, or shortage of required staff. In this study, nonfatal adverse events were not excessive in either group; despite early mobilization, no patients sustained a fall.

One study weakness is that only 200 of the 665 potentially eligible patients (30%) were included in the trial, implying that only a fraction of all surgical ICU patients would be eligible for an enhanced program. Nevertheless, for those patients who are eligible, the results seem to be substantial.

Abstract

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