title: Safety of Patient Mobilization and Rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis.
abstract: BACKGROUND
  Early mobilization and rehabilitation of patients in intensive care units (ICUs) may improve physical function, and reduce the duration of delirium, mechanical ventilation, and ICU length of stay. However, safety concerns are an important barrier to widespread implementation.
  
  
  OBJECTIVE
  To synthesize safety data regarding patient mobilization and rehabilitation in the ICU, including falls, removal of endotracheal tubes, removal or dysfunction of intravascular catheters, removal of other catheters/tubes, cardiac arrest, hemodynamic changes, and desaturation.
  
  
  METHODS
  Systematic literature review, including searches of five databases. Eligible studies evaluated patients who received mobilization-related interventions in the ICU. Exclusion criteria included: (1) case series with fewer than 10 patients; (2) majority of patients under 18 years of age; and (3) data not reported to permit calculation of incidence of safety events.
  
  
  METHODS
  Number of patients, mobilization/rehabilitation sessions, potential safety events, and events with negative consequences (e.g., requiring intervention or additional therapy).
  
  
  RESULTS
  Heterogeneity was assessed by I2statistics, and bias assessed by the Newcastle-Ottawa Scale and Cochrane risk of bias assessment. The literature search identified 20,660 titles. There were 48 eligible publications evaluating 7,546 patients, with 583 potential safety events occurring in 22,351 mobilization/rehabilitation sessions. There was a total of 583 (2.6%) potential safety events with heterogeneity in the definitions for these events. For the safety event types that could be meta-analyzed, pooled incidences per 1,000 mobilization/rehabilitation sessions (95% confidence interval), were: hemodynamic changes, 3.8 (1.3-11.4), and desaturation, 1.9 (0.9-4.3). A total of 24 studies of 3,404 patients reported on any consequences of potential safety events (e.g., needing to increase dose of vasopressor due to mobility-related hypotension), with a frequency of 0.6% in 14,398 mobilization/rehabilitation sessions.
  
  
  CONCLUSIONS
  Patient mobilization and physical rehabilitation in the ICU appears safe, with a low incidence of potential safety events, and only rare events having any consequences for patient management. Heterogeneity in the definition of safety events across studies emphasizes the importance of implementing existing consensus-based definitions.
authors.affiliation: 1 Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-5178-0364
authors.initials: P
authors.lastname: Nydahl
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Thammasat University, PathumThani, Thailand.
authors.forename: Thiti
authors.initials: T
authors.lastname: Sricharoenchai
authors.affiliation: 3 Telehealth Program, Northwell Health, New York, New York.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chandra
authors.affiliation: 4 Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Firuzan Sari
authors.initials: FS
authors.lastname: Kundt
authors.affiliation: 5 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Minxuan
authors.initials: M
authors.lastname: Huang
authors.affiliation: 6 Nursing Development, University Hospital Salzburg, Salzburg, Austria; and.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Fischill
authors.affiliation: 7 Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D019090:Case Management; D016638:Critical Illness / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay / Q000706:statistics & numerical data*; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects
keywords: adverse effects; early ambulation; exercise; patient safety