title: Teamwork enables high level of early mobilization in critically ill patients.
abstract: BACKGROUND
  Early mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients.
  
  
  RESULTS
  General practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15-23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients' refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients' subjective perception of physical therapy was reported to be enjoyable.
  
  
  CONCLUSIONS
  Mobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Cheryl Elizabeth
authors.initials: CE
authors.lastname: Hickmann
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Diego
authors.initials: D
authors.lastname: Castanares-Zapatero
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bialais
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dugernier
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Antoine
authors.initials: A
authors.lastname: Tordeur
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Lise
authors.initials: L
authors.lastname: Colmant
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tirone
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Roeseler
authors.affiliation: Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium. pierre-francois.laterre@uclouvain.be.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
keywords: Early mobilization; Intensive care unit; Mechanical ventilation; Perception; Physical therapy; Teamwork