title: Early mobilization in the critical care unit: A review of adult and pediatric literature.
abstract: Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
authors.affiliation: Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study.
authors.forename: Saoirse
authors.initials: S
authors.lastname: Cameron
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Ball
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medical Biophysics, Western University, London, ON, Canada.
authors.forename: Gediminas
authors.initials: G
authors.lastname: Cepinskas
authors.affiliation: Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Pediatrics, McMaster University, Hamilton, ON, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.affiliation: Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Physical Medicine and Rehabilitation, Western University, London, ON, Canada.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Doherty
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada; Medical Biophysics, Western University, London, ON, Canada.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Ellis
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Medicine, Western University, London, ON, Canada.
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Martin
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Surgery, Western University, London, ON, Canada.
authors.forename: Tina S
authors.initials: TS
authors.lastname: Mele
authors.affiliation: Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Anesthesia and Perioperative Medicine, Western University, London, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.affiliation: Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Kinesiology, Western University, London, ON, Canada.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Shoemaker
authors.affiliation: Functional Recovery in Critically Ill Children: The "Wee-Cover" Longitudinal Cohort Study; Targeted Exercise to Reduce Morbidity and Mortality in Severe Sepsis (TERMS) Study; Pediatrics, Western University, London, ON, Canada. Electronic address: douglas.fraser@lhsc.on.ca.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Fraser
mesh_terms: D000328:Adult; D002648:Child; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000534:rehabilitation*; D004434:Early Ambulation / Q000379:methods*; D061345:Early Medical Intervention; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D026741:Physical Therapy Modalities; D012449:Safety
keywords: Adult; Exercise; Intensive care unit; Intervention; Mobility; Pediatric