Safety of Early Mobilisation and Rehabilitation in Critically Ill Patients: A Prospective Multicentre Cohort Study
This prospective multicentre cohort study demonstrates that early mobilisation and rehabilitation in critically ill patients, including those receiving vasopressor support, is generally safe with infrequent, transient adverse events and no statistically significant association between vasopressor use and safety incidents.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, the standard approach to caring for patients in intensive care units was to keep them still. The logic was sound: if a person is fighting for their life, with tubes in their veins and machines breathing for them, the safest place is a bed. But doctors and therapists began to notice a troubling pattern. Patients who stayed immobile for days or weeks often woke up with muscles that had wasted away, joints that had stiffened, and minds that had become foggy. This collection of problems, now known as ICU-acquired weakness, could turn a short hospital stay into a lifelong struggle with disability. To prevent this, medical teams started trying something different: getting patients moving while they were still critically ill. They would help a patient sit up, stand, or even take a few steps, often within the first few days of admission.
However, this shift in practice created a new, urgent question. If a patient is so sick that they need powerful drugs to keep their blood pressure up, is it safe to make them stand? Many medical teams hesitated, fearing that the physical effort of moving could cause a patient's heart to race, their blood pressure to crash, or their oxygen levels to drop dangerously low. This uncertainty meant that some patients who might have benefited from movement were left in bed, simply because the rules for who could move were unclear. A new study set out to answer this question by watching what actually happened when critically ill patients, including those on life-support drugs, were helped to move.
The researchers, working across four major hospitals in Bogotá, Colombia, followed 262 adult patients over several months. These were not healthy volunteers; they were people with severe illnesses, some of whom were on ventilators and others who were receiving continuous infusions of medication to support their circulation. The team did not just watch these patients; they actively helped them move. Trained therapists assessed each person and guided them through a series of activities tailored to their strength. Some sessions involved passive movement, where the therapist moved the patient's limbs. Others were more active, requiring the patient to sit on the edge of the bed, stand, or walk. In total, the team recorded more than 1,100 of these movement sessions.
The primary goal was to see if moving these fragile patients caused harm. The team defined "harm" broadly, looking for things like a sudden drop in oxygen, a dangerous change in heart rhythm, or a spike or crash in blood pressure. They also paid close attention to the patients who were receiving vasopressors, the drugs used to keep blood pressure stable. The researchers wanted to know if the presence of these drugs made movement more dangerous. They tracked every session, noting the patient's vital signs before and after the activity, and recorded any time something went wrong.
The results were surprisingly reassuring. Out of the 1,136 sessions performed, only 26 safety events occurred. This means that in roughly 98 out of every 100 sessions, the patients moved without any adverse reaction. When problems did happen, they were almost always minor and temporary. The most common issues were a brief dip in oxygen levels or a momentary change in blood pressure. Crucially, none of these events required the therapists to stop the session. In only one single case did a patient need a tiny, temporary increase in their medication to stabilize their blood pressure, and even then, the session continued. The vast majority of patients moved through their exercises without needing any medical intervention at all.
The study also looked specifically at the patients receiving vasopressor support. About one-fifth of all the sessions were done while these drugs were running. The researchers compared the safety of these sessions against those where no such drugs were used. They found no significant difference in the rate of problems. Whether a patient was on a low dose of medication to support their blood pressure or no medication at all, the risk of a safety event remained very low. This suggests that the presence of these drugs, often seen as a strict barrier to movement, does not automatically make a patient too unstable to move.
The researchers also examined how the patients responded physically. During the sessions, heart rates and breathing rates went up slightly, which is a normal reaction to exercise. Blood pressure rose just a little, and oxygen levels stayed steady. The patients were able to progress over time, moving from simple bed exercises to standing and walking. The study did not prove that moving these patients cured their weakness, as there was no control group to compare them against, but it did prove that the act of moving them was safe. The events that did occur were rare, fleeting, and manageable.
This work challenges the old idea that critically ill patients must remain still until they are fully recovered. It shows that with careful monitoring and a structured plan, even patients on powerful life-support drugs can be moved safely. The findings do not suggest that every patient should be moved immediately, nor do they claim that movement is risk-free. Instead, they provide evidence that the fear of moving a patient on vasopressors may be greater than the actual danger. By showing that safety events are infrequent and rarely serious, the study offers a path forward for medical teams to help patients regain their strength sooner, potentially reducing the long-term disability that often follows a stay in the intensive care unit.
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