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Objective: Immobilization and subsequent weakness are conse- patients were out of bed earlier (5 vs. 11 days, p < .001), had
quences of critical illness. Despite the theoretical advantages of therapy initiated more frequently in the intensive care unit (91%
physical therapy to address this problem, it has not been shown that vs. 13%, p < .001), and had similar low complication rates
physical therapy initiated in the intensive care unit offers benefit. compared with Usual Care. For Protocol patients, intensive care
Design and Setting: Prospective cohort study in a university unit length of stay was 5.5 vs. 6.9 days for Usual Care (p .025);
medical intensive care unit that assessed whether a mobility hospital length of stay for Protocol patients was 11.2 vs. 14.5 days
protocol increased the proportion of intensive care unit patients for Usual Care (p .006) (intensive care unit/hospital length of
receiving physical therapy vs. usual care. stay adjusted for body mass index, Acute Physiology and Chronic
Patients: Medical intensive care unit patients with acute re- Health Evaluation II, vasopressor). There were no untoward events
spiratory failure requiring mechanical ventilation on admission: during an intensive care unit Mobility session and no cost differ-
Protocol, n 165; Usual Care, n 165. ence (survivors nonsurvivors) between the two arms, including
Interventions: An intensive care unit Mobility Team (critical Mobility Team costs.
care nurse, nursing assistant, physical therapist) initiated the Conclusions: A Mobility Team using a mobility protocol initi-
protocol within 48 hrs of mechanical ventilation. ated earlier physical therapy that was feasible, safe, did not
Measurements and Main Results: The primary outcome was increase costs, and was associated with decreased intensive care
the proportion of patients receiving physical therapy in patients unit and hospital length of stay in survivors who received physical
surviving to hospital discharge. Baseline characteristics were therapy during intensive care unit treatment compared with patients
similar between groups. Outcome data are reflective of survivors. who received usual care. (Crit Care Med 2008; 36:2238 2243)
More Protocol patients received at least one physical therapy KEY WORDS: respiratory failure; mechanical ventilation; mobility;
session than did Usual Care (80% vs. 47%, p < .001). Protocol intensive care units; physical therapy; passive range of motion
I mmobility, deconditioning, and hospitalization (1, 2). Although physical variability in the delivery of physical ther-
weakness are common problems therapy has a theoretical appeal and may apy to ICU patients may be the lack of a
in mechanically ventilated pa- address this problem, it has not been de- uniform protocolized approach for ICU
tients with acute respiratory fail- termined whether physical therapy has delivery of physical therapy. Such proto-
ure, and may contribute to prolonged increased benefit when initiated early cols exists for other ICU interventions:
during intensive care unit (ICU) treat- weaning from mechanical ventilation,
ment. There may be perceived barriers to liberation from sedation, and early goal
*See also p. 2444. the consistent delivery of passive range of directed therapies for severe sepsis (79).
From the Section on Pulmonary, Critical Care,
Allergy and Immunologic Diseases (PEM, AH, RDH, EH), motion (PROM) and physical therapy in To our knowledge there are no previous
and Public Health Sciences (Le.P), Wake Forest Uni- many ICUs, namely concern over appara- studies that assess efficacy, cost, or hos-
versity School of Medicine, Winston Salem, NC; De- tus dislodgment, integration of mobility pital or long-term benefits of early ICU
partments of Nursing, Physical Therapy, and Hospital with sedation needs, costs of physical Mobility therapy in medical ICU patients.
Administration (AG, CT, KT, BH, AR, LA, SB, MS, La.P,
LD, SL, RS), North Carolina Baptist Hospital, Winston therapists in ICUs and time restraints of As part of a quality improvement project
Salem, NC. both nurses and physical therapists (3). we developed a standard physical therapy
Supported, in part, by The North Carolina Baptist Although exercise has been shown to im- protocol for use in medical ICU patients.
Hospital and The Claude D. Pepper Older Americans
Independence Center of Wake Forest University, NIH
prove functional outcome in emphysema In our ICUs physical therapy is part of
Grant P60AG10484. and heart failure in the outpatient set- usual care; however, delivery and admin-
The authors have not disclosed any potential con- ting, few data exist regarding whether istration of physical therapy is often in-
flicts of interest. early mobility of the medical ICU patient frequent and occurs irregularly. The mo-
For information regarding this article, E-mail:
pemorris@wfubmc.edu will improve outcomes (4, 5). bility protocol was designed to provide a
Copyright 2008 by the Society of Critical Care Physical therapy practice in the ICU mechanism (i.e., the protocol and Mobil-
Medicine and Lippincott Williams & Wilkins setting varies greatly from one setting to ity Team) for standard and frequent (once
DOI: 10.1097/CCM.0b013e318180b90e another (6). One reason for the observed every day) administration of physical