The efficacy and safety of early mobilization in mechanically ventilated ICU patients: a systematic review of randomized controlled trials

Commonly recommended in the prevention of intensive care unit-acquired weakness (ICU-AW) in critically ill patients, early mobilization (EM) is an emerging therapeutic strategy, but its efficacy, harm, and optimal intensity remain poorly defined. Based on PRISMA 2020 guidelines, 13 randomized controlled trials (RCTs) of EM compared to usual care were examined. The analyses assessed EM efficacy (ICU-AW frequency, clinical function) and safety (adverse outcomes). These data pools were incorporated to identify the overall effects of these outcomes and to evaluate the potential for bias in pooled studies. EM also showed improvement in decreasing ICU-AW. Pooled data incidence rates within intervention groups fell to as low as 2%, compared to a level of 16-54% within control groups. As the Barthel Index tracks, functional status post-hospital discharge significantly improved with EM. That effectiveness was, however, partially countered by a strong safety signal. In the most extensive RCT, adverse events were observed in 9.2% of patients receiving EM versus 4.1% in controls. Higher-dose EM regimens did not improve primary outcomes (e.g., "days alive and out of hospital") compared to standard care. There was no clear effect on mortality. EM was both a high-risk, high-return strategy and was recovery-related, as well as injury-promoting. They do not support the \"more is better\" mantra. Clinical practice should therefore focus on the use of EM that is standardized, safety-oriented, versus aggressive high-intensity EM techniques in medical treatment. Further research should focus on individualized rehabilitation, showing patient subgroups of patients more amenable to specific mobilization methods.