Moving our critically ill patients: Mobility barriers and benefits

In the last quarter-century, research developments have led to improvements in diagnosis and resuscitation of critically ill patients. With these improvements, survival for many populations of critically ill patients has increased [1-6]. With these improvements in mortality, the field of critical care has seen increased opportunities to affect the immediate posthospital quality of life for survivors of critical illness. The concept of a successful outcome for an ICU patient has gone through meaningful maturation in the last decade. Not too long ago, for clinical trials in critical care, being alive at 28 days or alive and off the ventilator were the sole endpoints. Examination of ICU processes of care has led to longer periods of observation to determine survival endpoints. Recently, critical care experts also have focused on management factors that may affect survivors' quality of life. Many investigators have become interested in aspects of ICU practice that may affect the speed with which a person may return to premorbid function [7,8]. Authors' descriptions of ICU sequelae long after the 28-day mark have demonstrated mental and physical limitations [7,8]. This issue of Critical Care Clinics will explore care of the critically ill patient from the viewpoint of how ICU mobilization may benefit patients and how usual practice may inhibit the delivery of mobilization.