Early activity in the ICU: beyond safety and feasibility.

Often critical care providers think that critically ill patients are too sick to tolerate vigorous activity in the early phase of their illness, thereby incurring “unavoidable” prolonged immobilization. Prolonged immobilization is a substantial contributor to neuromuscular abnormalities, resulting in weakness that may complicate the clinical course of a majority of critically ill patients.1-5 Immobilization is also associated with substantial morbidity and may affect the rate of recovery and return to the patient’s former level of function after critical illness and intensive care unit (ICU) treatment. A prospective study of 109 patients with acute respiratory distress syndrome found that patients lost an average of 18% of their body weight in the ICU and were able to walk only 66% of their predicted 6-min walk distance at 1-year follow-up.4 Many of these patients had physical disabilities due to immobility, and almost half of the patients were unable to return to work due to persistent fatigue, weakness, and poor functional status 1 year after hospital discharge.4 To improve physical function after prolonged critical illness and ICU treatment, post-ICU physical rehabilitation is advocated.6,7