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Critical Care

Early mobility in the ICU: physician perspectives

Early mobility has become an increasingly important topic in critical care medicine. To help spread the word on this key issue, we talked to Dr. Paul Marik and Dr. Bruce Friedman, two intensivists at the forefront of this topic.

Why is early mobility an important topic?
Dr. Marik emphasizes the enduring impact either sedation or mobility can have on ICU survivors’ quality of life.



Why is early mobility so hard to implement?
Early mobility requires a change in the ICU culture.1 Dr. Marik explains why this can be difficult, even with a protocol in place.



How do you implement early mobility in burn patients?
Dr. Friedman shares some of the special considerations that come with helping burn patients become ambulatory.



How do you measure delirium?
Studies suggest a role for early mobility in reducing the duration of delirium in ICU patients.2,3 But how do you know whether a patient is delirious in the first place? Dr. Marik explains how his unit monitors patients for the development of delirium, and in the process provides an explanation of the CAM-ICU score.



How should ICU care evolve to address post-intensive care syndrome?
Dr. Marik emphasizes the importance of requiring earlier ICU rehabilitation and more follow-up with patients post-ICU discharge.



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Dr. Paul Marik and Dr. Bruce Friedman are not paid consultants to Cook Medical.


1 Bailey PP, Miller RR, Clemmer TP. Culture of early mobility in mechanically ventilated patients. Crit Care Med. 2009;37 suppl 10:S429-S435. doi:10.1097/CCM.0b013e3181b6e227.

2 Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–1882. [PubMed]

3 Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536–542. [PubMed]