1. Section Editor(s): Shever, Leah L. PhD, RN
  2. Dickinson, Sharon MSN, RN, CNS-BC, ANP, CCRN

Article Content

This issue of Critical Care Nursing Quarterly is dedicated to "Mobility: A Successful Investment for Critically Ill Patients."


Critical illness represents an immediate threat to life and requires an intensive care unit (ICU) admission. One of the major roles of an ICU, up until now, has been to treat patients with reversible forms (short-term survival) of critical illness. With more than 80% of critically ill patients surviving to hospital discharge, the focus has changed from short-term survival to long-term recovery from critical illness. Long-term recovery encompasses both physiologic and psychological complications of prolonged critical illness.1-3 Physical immobility associated with bed rest contributes to neurocognitive and functional complications of prolonged illness.4,5 The consequences of bed rest and immobility affect every body system and has been well documented in the literature.6-8 Short-term stays in an ICU can result in the development of ventilator-associated pneumonia, hospital-acquired pneumonia, atelectasis, and skin ulcers.7 Extended stays in an ICU can cause muscle weakness, physical deconditioning, psychological alterations, and poor quality of life.1-8 Integrated programs dealing with both whole-body physical therapy (mobility protocols) and restoration of muscle function can be used to reduce complications of critical illness.


This issue of Critical Care Nursing Quarterly is designed to give the reader a holistic summary of mobility in a critical care unit, starting with basic science but getting down to the details of special considerations with unique patient populations. The issue begins with an editorial about one institution's experiences on how mobility became an integral part of its nursing model of care during challenging times and competing priorities. Next, we start with a review of the science and mechanisms for muscle health in the ICU patient. This leads to a discussion of how those mechanisms impact the patient's hemodynamic responses, and methods that can be used to safely mobilize the patient. An important consideration in the patient's response to mobility is their nutritional status and the energy requirements associated with mobility. That science, along with strategies to ensure adequate nutrition, is described in the article by Cherry-Bukowiec. The next article includes a review of the literature and a description of a mobility protocol developed on the basis of that evidence. But even with an evidence-based framework in hand, there will always be questions, special considerations, and barriers to mobilizing patients. The reader is given further evidence and operational considerations to implement mobility in a variety of patient populations including patients with neurosurgery, burn, abdominal surgery, and cardiac surgery and even extending to patients with renal failure who require continuous renal replacement therapy. Related to this is an article that outlines the equipment that can and should be used to safely mobilize the ICU patient.


Once the science, literature, protocols, and special considerations have been defined, the next step is implementation. One unit's strategies around implementing a multidisciplinary team's mobility protocol are outlined in the article by Dammeyer, Dickinson and colleagues. The costs associated with implementation of a mobility protocol are outlined in a separate article. Of course, the reason for doing all of this work related to early mobility is to improve outcomes for ICU patients and their families. A preliminary evaluation of how early mobility impacts pressure ulcers is described in the article by Dickinson et al. The importance of family engagement in a mobility protocol is outlined by the final article in this issue.


In this issue, the reader will see articles that outline the science and evidence behind early mobility in the ICU, as well as several innovative, operational approaches used by a wide variety of adult ICUs (eg, medical, surgical, neurological, cardiovascular), to promote mobility in our ICU patients with complex conditions. The issue editors feel that many of these approaches improve quality significantly by focusing on evidence-based practice, multidisciplinary teamwork, and standardization, as well as using quality improvement data to inform care processes. The issue editors hope that the reader better understand the evidence behind early mobility as well as find practical, approaches to implementation in their practice settings.


-Leah L. Shever, PhD, RN


Sharon Dickinson, MSN, RN, CNS-BC, ANP, CCRN


Issue Editors




1. Herridge MS, Cheung AM, Tansey CM, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683-693. [Context Link]


2. Dickinson S. Functional outcomes after extracorporeal membrane oxygenation therapy for adult respiratory distress syndrome [thesis]. Livonia, MI: Madonna University; 1998.


3. Dowdy DW, Edi MO, Sedrakyan A, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31:611-620. [Context Link]


4. Hopkins RO, Ely EW, Jackson JC. The role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of brain dysfunction. Curr Opin Crit Care. 2007;12:497-502. [Context Link]


5. Fan E, Zanni JM, Dennison CR, Lepre SJ, Needham DM. Critical illness neuropathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care. 2009;20(3):243-263. [Context Link]


6. Hough Cl, Needman DM. The role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of weakness and neuromuscular dysfunction. Curr Opin Crit Care. 2007;12:489-496. [Context Link]


7. Vollman K. Introduction to progressive mobility. Pro-gressive Mobility in the Critically Ill, a supplement to Crit Care Nurse. 2010;30(2, suppl 3):S3-S4. [Context Link]


8. Bower RG. Consequences of bed rest. Crit Care Med. 2009;37(10):422-428. [Context Link]