Active Mobilization for Mechanically Ventilated Patients: A Systematic Review

Objective: To investigate the effectiveness and safety of active mobilization on improving physical function and hospital outcomes in patients undergoing mechanical ventilation for more than 24 hours. Data Sources: PubMed, Embase, CINAHL, CENTRAL, Physiotherapy Evidence Database, SinoMed, and ISI Web of Knowledge were searched for randomized controlled trials (RCTs), quasi-RCTs, other comparative studies, and case series with 10 or more consecutive cases. Additional studies were identified through references, citation tracking, and by contacting the authors of eligible studies. Study Selection: Two reviewers independently selected potential studies according to the inclusion criteria. Data Extraction: Two reviewers independently extracted data and assessed the methodologic quality. Data Synthesis: A narrative form was used to summarize study characteristics and outcomes, because the substantial heterogeneity between the individual studies precluded formal meta-analyses. Among the 17 eligible studies, 7 RCTs, 1 quasi-RCT, 1 prospective cohort study, and 1 history controlled study were used to examine the effectiveness; and 2 RCTs, 1 prospective cohort study, and 7 case series were used to examine the safety of active mobilization in patients receiving mechanical ventilation for more than 24 hours. We found that active mobilization may improve muscle strength, functional independence, and the ability to wean from ventilation and may decrease the length of stay in the intensive care unit (ICU) and hospital. However, only 1 study reported that active mobilization reduced the 1-year mortality rate. No serious adverse events were reported among included studies. Conclusions: Active mobilization appears to have a positive effect on physical function and hospital outcomes in mechanical ventilation patients. Early active mobilization protocols may be initiated safely in the ICU setting and continued in post-ICU settings. However, the current available studies have great heterogeneity and limited methodologic quality. Further research is needed to provide more robust evidence to support the effectiveness and safety of active mobilization. Archives of Physical Medicine and Rehabilitation 2013;94:551-61 (C) 2013 by the American Congress of Rehabilitation Medicine