Benefits of early mobilization in the MICU

Over the years, the benefits of exercise for patients has gained momentum. Forty years ago, studies showed that getting heart attack patients out of bed as soon as possible led to a faster recovery.  The same turnaround occurred with patients with back pain in the 1990s. More recently, evidence shows that these benefits could also be realized in critically ill medical patients. William Schweickert, MD, associate medical director of the MICU and medical director of the Procedure and Resuscitation Service, was the lead author of a landmark trial published in the journal Lancet that clearly demonstrated these findings.

MICU patient Cole Warminsky is up and walking  with help from (l. to r.) physical therapist Kelly Butler, respiratory therapist Florence Holland, and respiratory student Shelagh Humes.

Traditionally critically ill patients have been viewed as too sick to tolerate early physical activity in the ICU but "patients can also suffer adverse effects from immobility," said Joe Adler, MSPT, CCS, Acute Care team leader of Occupational and Physical Therapy. While MICU patients are very sick,  "a relatively large percentage can safely undergo exercise and mobilization even during mechanical ventilation and while on vasopressor infustions."

“We have standardized many other complex ICU care processes, using the expertise of our faculty and the power of interdisciplinary team work,” said Barry Fuchs, MD, MICU medical director. “Our patients are now being managed with less sedation and can be more engaged.  Early mobilization was a natural next step.” 

 Very Promising Results

Once  approved to expand the pool of physical therapists in the MICU, the care team collaborately developed the program of early mobilization. Physicans, nurses, and respiratory and physical therapists in the MICU established a new clinical protocol with specific eligibility and safety criteria to identify suitable patients for early and safe mobilization. To ensure implementation they added formalized reporting of physical functioning and reminders for PT consultation to the interdisciplinary rounds checklist and developed standardized tools for measuring patient progress. Dedicated physical therapists certified to work with ICU patients worked with "careful collaboration with the patient's bedside nurse and the entire care team,” Adler said.

The results of the mobiliation program were more than encouraging. The average ICU stay for all MICU patients was reduced by one day.  Furthermore, patient physical function was substantially improved at ICU discharge.  Patients in the program exhibited a greater ability to sit upright, transfer out of bed, and walk independently and for longer distances when compared to patients during the prior level of care.

“Although the pilot was a success, we believe we can confer even more benefit as we reach our planned staffing level,” Schweickert said. “We envision patients receiving aggressive physical and occupational therapy services six days per week to fully recreate the environment and success of prior clinical trials.”