Best Practices for Early Mobilization of Intensive Care Unit Patients: A Narrative Review

Background: Prolonged immobilization in intensive care units (ICUs) leads to muscle weakness, protracted time to recovery, and the development of intensive care unit-acquired weakness (ICUAW), which can adversely impact patient outcomes. Early mobility (EM) or organized physical activities for the ICU patient population are approaches to combat prolonged immobilization and improve recovery. Aim: This narrative review aimed to investigate best practices for this intervention in ICU patients, including, but not limited to, successful protocols, EM tools, barriers, and ICU patient clinical outcomes to establish clinical practice. Methods: The literature was reviewed from 2010-2024 using PubMed, Scopus, and Web of Science databases. Included studies were randomized controlled trials, observational studies, and clinical guidelines pertaining to adult ICU patients. Studies were narratively synthesized to identify the best EM approaches, equipment, and implementation barriers. Results: Analysis of studies found that EM reduces the length of stay (LOS) by approximately 1.5-2 days while increasing muscle strength (e.g., Medical Research Council scale), and functional independence (e.g., Barthel Index evidence). Nurse-led and multidisciplinary approaches were most effective with the use of EM tools such as cycle ergometers and electronic health record systems. Key barriers included excessive sedation, staffing issues, and physiologic instability of the patient; therefore, individualized interventions are necessary. Conclusions: EM in the ICU effectively translates to better patient outcomes, but requires standardized, evidence-based, explicit protocols, interdisciplinary team collaboration, and must allocate adequate resources to address barriers related to EM. Staff awareness and training, and patient-centered approaches must be employed to support successful EM implementation.