Effects of early rehabilitation with a physiatrist and a registered therapist operating acute rehabilitation in mechanically ventilated ICU patients: a prospective observational study

IntroductionProlonged immobilization in the intensive care unit (ICU) leads to ICU-acquired weakness (ICU-AW), which delays ventilator liberation and worsens outcomes. Although early mobilization is beneficial, and the Physiatrist and Registered Therapist Operating Acute Rehabilitation (PROr) program has been associated with improved functional recovery and higher home-discharge rates in stroke populations, its effectiveness in mechanically ventilated ICU patients remains unclear. This study aimed to evaluate the safety and effectiveness of the PROr in mechanically ventilated ICU patients.MethodsWe conducted a single-center, prospective observational study from 2013 to 2017. Adults requiring mechanical ventilation with a pre-admission Barthel Index (BI) ≥ 70 were included. Patients were assigned to early mobilization (EM; within 48 h of ICU admission) or usual mobilization (UM; after 48 h). Primary outcomes were duration of mechanical ventilation and ICU length of stay. Secondary outcomes included neurological responsiveness and functional recovery at discharge.ResultsSixty-nine patients were analyzed (44 EM, 25 UM), with comparable baseline characteristics. EM was associated with shorter median ventilation duration (5.5 vs. 7.7 days; p < 0.05) and ICU stay (9.1 vs. 11.6 days; p < 0.05). Eye-opening scores on the Glasgow Coma Scale significantly improved during mobilization in both groups, whereas Motor-response scores showed no significant differences. Functional outcomes at discharge (BI, FIM) were similar between groups. No adverse events occurred during mobilization.ConclusionsMobilization within 48 h under the PROr did not induce any clinical adverse events and significantly reduced ventilation duration and the length of ICU stay. Mobilization of mechanically ventilated unconsciousness ICU patients may improve levels of consciousness.