Keywords
Early Ambulation
Physical Therapy Speciallty
Clinical Protocols
Patient Safety
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Abstract
Objective: To analyze contemporary scientific evidence regarding the clinical, organizational, and professional barriers that limit the implementation of early mobilization in adults admitted to Intensive Care Units. Methods: Integrative review developed according to the Whittemore and Knafl framework, with searches in PubMed, SciELO, LILACS, Scopus, and Web of Science databases (2021-2026). The PICO model was used for data selection and extraction from 09 high-relevance articles, focusing on healthcare barriers and safety criteria. Results: The findings demonstrate a paradigm shift from "maximum intensity" to "prudent precocity." The main identified barriers include hemodynamic instability and deep sedation (clinical), staff fear regarding adverse events (professional), and personnel deficits combined with a shortage of assistive technologies (organizational). Systematization via the ABCDEF bundle and the use of the "Safety Traffic Light" emerge as crucial strategies to mitigate therapeutic inertia and acquired weakness. Final considerations: The study evidences that the success of early mobilization depends on overcoming cultural and structural barriers through clinical governance. The primary limitation lies in the heterogeneity of protocols among intensive care centers.
References
ADLER J, MALONE D. Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary Physical Therapy Journal, 2012; 23(1): 5 - 13.
ANEKWE DE, et al. Barriers and facilitators to early mobilization in intensive care units in low- and middle-income countries. Physiotherapy Theory and Practice, 2021; 37(9): 980 - 994.
AQUIM EE, et al. Diretrizes Brasileiras de Mobilização Precoce em Unidade de Terapia Intensiva. Revista Brasileira de Terapia Intensiva, 2019; 31(4): 434 - 443.
BARR J, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 2013; 41(1): 263 - 306.
CHEUNG K, et al. Safety and adverse events of early mobilization in the intensive care unit: a systematic review and meta-analysis. Intensive Care Medicine, 2023; 49(4): 412 - 425.
DEVLIN JW, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption. Critical Care Medicine, 2018; 46(9): e825 - e873.
DUBB R, et al. Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Annals of the American Thoracic Society, 2016; 13(5): 724 - 730.
ELY EW. The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families. Critical Care Medicine, 2017; 45(2): 321 - 330.
FAN E, et al. Physical complications in survivors of critical illness. Current Opinion in Critical Care, 2014; 20(4): 397 - 401.
FONTELA PS, et al. Barriers to early mobilization in the intensive care unit: a Brazilian multicenter study. Fisioterapia em Movimento, 2022; 35: e35102.
GORDON A, et al. Protocol fatigue and organizational barriers to sustainable early mobilization in the ICU. Journal of Intensive Care Implementation, 2025; 12(1): 102 - 115.
HERMANS G, VAN DEN BERGHE G. Clinical review: intensive care unit acquired weakness. Critical Care, 2015; 19(1): 274.
HODGSON CL, et al. Early mobilization and recovery in dialysis-requiring acute kidney injury. American Journal of Respiratory and Critical Care Medicine, 2013; 187(4): 341 - 343.
HODGSON CL, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 2014; 18(6): 658.
HODGSON CL, et al. Early Active Mobilization during Mechanical Ventilation in the ICU. New England Journal of Medicine, 2022; 387(19): 1747 - 1758.
HOSEY MM, et al. Early mobilization and its association with post-intensive care syndrome (PICS). Critical Care Medicine, 2021; 49(12): 2011 - 2022.
JOLLEY SE, et al. Physical therapy utilization and mobility in a national sample of critically ill adults. Critical Care Medicine, 2017; 45(1): 115 - 124.
LATRONICO N, et al. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurology, 2011; 10(10): 931 - 941.
LIU K, et al. Impact of a structured education program on the safety culture of early mobilization in ICU. Nursing in Critical Care, 2024; 29(1): 45 - 54.
MARRA A, et al. The ABCDEF Bundle in Critical Care. Critical Care Clinics, 2017; 33(2): 225 - 243.
MENG L, et al. Early mobilization for the prevention of delirium in critically ill patients: a systematic review and meta-analysis. International Journal of Nursing Studies, 2021; 114: 103831.
MORRIS PE, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 2008; 36(8): 2238 - 2243.
NEEDHAM DM. Mobilizing patients in the intensive care unit: improving neuromuscular function and physical outcomes. JAMA, 2008; 300(14): 1685 - 1690.
PARRY SM, et al. Exercise rehabilitation following hospital discharge in survivors of critical illness: a systematic review and meta-analysis. Critical Care Medicine, 2018; 46(1): 124 - 132.
PATON M, et al. Mobilization of patients on ECMO and with morbid obesity: a scoping review of safety and barriers. Physical Therapy in Health Care, 2023; 40(2): 88 - 102.
PUN BT, et al. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative. Critical Care Medicine, 2019; 47(1): 3 - 14.
RAWAL G, BAKHRU RN. Barriers to early mobilization in the critically ill: from evidence to implementation science. Current Opinion in Critical Care, 2024; 30(3): 215 - 222.
SAKURAMOTO H, et al. Implementation of the ABCDEF bundle and its impact on clinical outcomes in Brazilian ICUs. Revista Brasileira de Terapia Intensiva, 2023; 35(2): 145 - 156.
SCHALLER SJ, et al. International clinical practice guidelines for early mobilization in the ICU: a formal consensus. Intensive Care Medicine, 2024; 50(1): 12 - 34.
SCHWEICKERT WD, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 2009; 373(9678): 1874 - 1882.
STILLER K. Safety issues that should be considered when mobilizing critically ill patients. Critical Care Clinics, 2007; 23(1): 35 - 53.
TIMPEL P, et al. Digital and Assistive Technologies to Support Early Mobilization in the ICU: A 2024 Scoping Review. Intensive Care Medicine Experimental, 2024; 12: 5.
TRUONG AD, et al. Bench-to-bedside review: mobilizing patients in the intensive care unit--from pathophysiology to clinical trials. Critical Care, 2009; 13(4): 216.
WANG Y, et al. Effectiveness of early mobilization on physical function and ICU-acquired weakness: an updated integrative review. Journal of Advanced Nursing, 2023; 79(8): 2810 - 2825.
WHITTEMORE R, KNAFL K. The integrative review: updated methodology. Journal of Advanced Nursing, 2005; 52(5): 546 - 553.
ZHANG L, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One, 2019; 14(10): e0223185.
ZANG K, et al. The effect of early mobilization on the duration of mechanical ventilation: a prospective observational study. Journal of Clinical Nursing, 2022; 31(5-6): 742 - 753.
ZHANG Y, et al. Human resource scarcity as a barrier to daily mobilization surveillance in the ICU. Australian Critical Care, 2024; 37(1): 88 - 96.