https://doi.org/10.4081/scenario.2021.501

Early mobilisation and prevention of Intensive Care Unit Acquired Weakness (ICU-AW): a narrative review of the literature

Vol. 38 No. 4 (2021): SCENARIO 4, 2021
Submitted: 17 February 2022
Accepted: 17 February 2022
Published: 17 February 2022
Early mobilisation, intensive care, critical illness, acquired weakness
Abstract Views: 1185
PDF (Italiano): 701
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Authors

Sofia Sancisi
scenario@aniarti.it
Infermiere, Medicina Interna, Ospedale “G.Marconi”, Cesenatico (FC). AUSL della Romagna. Italia, .
Alessandro Monesi
Infermiere, Terapia Intensiva e Rianimazione, Ospedale Maggiore, AUSL di Bologna. Bologna. Italia, .
Guglielmo Imbrìaco
Infermiere, Centrale Operativa 118 Emilia Est, Emergenza Territoriale, Elisoccorso, Ospedale Maggiore, AUSL di Bologna. Bologna. Italia, .

Introduction: Intensive Care Unit Acquired Weakness (ICUAW) is a frequent complication that can occur in a high percentage of patients admitted to the intensive care unit, characterised by fatigue and neuromuscular weakness, and can persist even years after discharge. Early mobilisation interventions on critically ill patients, including during mechanical ventilation, have shown positive and encouraging results in preventing ICUAW.
Aim: To describe the efficacy, safety and feasibility of early mobilisation activities compared to standard mobilisation activities in the prevention of (ICUAW).
Materials and methods: Literature review of the major biomedical databases (Pubmed, Cochrane library, UpToDate, CINAHL - Cumulative Index to Nursing & Allied Health Database), using different search modes, in a 15-year retroactive mode. The search strategy was performed by combining the keywords "ICUAW", "Early Mobilization", "Adult", "Intensive Care Unit", "Critical Illness", defining criteria for inclusion and exclusion of studies.
Results: The initial search initially yielded 237 studies; after eliminating duplicates, applying search filters and following reading of title, abstract and full text, a total of 16 studies were considered: 5 systematic reviews, 4 randomised controlled trials, 6 reviews and 1 clinical trial.
Conclusions: Early mobilisation in the ICU was found to be a safe and feasible practice and the number of adverse events was extremely limited; it also increased the functional abilities of the patients, both during the hospital stay and at discharge, who were able to perform activities such as sitting at the foot of the bed, moving to an armchair to ambulation to a greater degree. The results regarding length of stay in intensive care and muscle strength were mixed. Further studies, with uniform outcome assessment criteria, would be needed to further investigate the effectiveness of these interventions.

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Scopus
Google Scholar
Europe PMC
Lipshutz AKM, Gropper MA. Acquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology. 2013;118(1):202–15. doi: 10.1097/ALN.0b013e31826be693.
De Jonghe B, Sharshar T, Lefaucheur J-P, Authier F-J, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002 Dec 11;288(22):2859-67. doi: 10.1001/jama.288.22.2859. PMID: 12472328.
Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: A systematic review. Intensive Care Med. 2007 Nov;33(11):1876-91. doi: 10.1007/s00134-007-0772-2.
Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome. N Engl J Med. 2003 Feb 20;348(8):683-93. doi: 10.1056/NEJMoa022450.
Schmidt UH, Knecht L, Macintyre NR. Should early mobilization be routine in mechanically ventilated patients? Respir Care. 2016 Jun;61(6):867-75. doi: 10.4187/respcare.04566. PMID: 27235319.
Sosnowski K, Lin F, Mitchell ML, White H. Early rehabilitation in the intensive care unit: An integrative literature review. Aust Crit Care. 2015 Nov;28(4):216-25. doi: 10.1016/j.aucc.2015.05.002.
Fan E, Zanni JM, Dennison CR, Lepre SJ, Needham DM. Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care. 2009 Jul-Sep;20(3):243-53. doi: 10.1097/NCI.0b013e3181ac2551.
Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011 May;341(5):373-7. doi: 10.1097/MAJ.0b013e31820ab4f6.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, De Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009 Oct;37(10 Suppl):S299-308. doi: 10.1097/CCM.0b013e3181b6ef67.
Kress JP, Hall JB. ICU-Acquired Weakness and Recovery from Critical Illness. N Engl J Med. 2014 Jul 17;371(3):287-8. doi: 10.1056/NEJMc1406274.
Tennilä A, Salmi T, Pettilä V, Roine RO, Varpula T, Takkunen O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000 Sep;26(9):1360-3. doi: 10.1007/s001340000586
Lacomis D, Shefner JM, Dashe JF. Neuromuscular weakness related to critical illness. UpToDate Literature review: Oct 2020, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on October 24, 2020)
Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev. 2014 Jan 30;2014(1):CD006832. doi: 10.1002/14651858.CD006832.pub3.
Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Mar 27;3(3):CD010754. doi: 10.1002/14651858.CD010754.pub2.
Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007 Jan;35(1):139-45. doi: 10.1097/01.CCM.0000251130.69568.87.
Eggmann S, Verra ML, Luder G, Takala J, Jakob SM. Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A study protocol for a randomised controlled trial. Trials. 2016 Aug 15;17:403. doi: 10.1186/s13063-016-1533-8.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9.
Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct 3;14(10):e0223185. doi: 10.1371/journal.pone.0223185.
Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012 Mar;23(1):5-13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22807649
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016 Oct 1;388(10052):1377-1388. doi: 10.1016/S0140-6736(16)31637-3.
Hashem MD, Nelliot A, Needham DM. Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future. Respir Care. 2016 Jul;61(7):971-9. doi: 10.4187/respcare.04741.
Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014 Dec 4;18(6):658. doi: 10.1186/s13054-014-0658-y.
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008 Aug;36(8):2238-43. doi: 10.1097/CCM.0b013e318180b90e.
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017 Apr;33(2):225-243. doi: 10.1016/j.ccc.2016.12.005.
McWilliams D, Jones C, Atkins G, Hodson J, Whitehouse T, Veenith T, et al. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial. J Crit Care. 2018 Apr;44:407-412. doi: 10.1016/j.jcrc.2018.01.001.
Katz S, Akpom CA. Index of ADL. Med Care [Internet]. 1976 May;14(Supplement):116–8. Available from: http://journals.lww.com/00005650-197605001-00018
Mikkelsen ME, Netzer G, Iwashyna T. Post-intensive care syndrome (PICS). UpToDate Literature review: Oct 2020, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on October 13, 2020)
Needham DM. Mobilizing patients in the intensive care unit: Improving neuromuscular weakness and physical function. JAMA. 2008 Oct 8;300(14):1685-90. doi: 10.1001/jama.300.14.1685.
Winkelman C. Inactivity and inflammation in the critically ill patient. Crit Care Clin. 2007 Jan;23(1):21-34. doi: 10.1016/j.ccc.2006.11.002.
Hamburg NM, McMackin CJ, Huang AL, Shenouda SM, Widlansky ME, Schulz E, et al. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol. 2007 Dec;27(12):2650-6. doi: 10.1161/ATVBAHA.107.153288
Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020 Jun;107:1-10. doi: 10.1016/j.physio.2019.12.004.
Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci. 2018 Sep;30(9):1193-1201. doi: 10.1589/jpts.30.1193.

How to Cite

Sancisi, S., Monesi, A., & Imbrìaco, G. (2022). Early mobilisation and prevention of Intensive Care Unit Acquired Weakness (ICU-AW): a narrative review of the literature. Scenario® - Il Nursing Nella Sopravvivenza, 38(4), 29–42. https://doi.org/10.4081/scenario.2021.501
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