In recent years, a number of studies have documented the safety and feasibility of early mobility in the ICU [
4‐
6]. In addition, early rehabilitation is associated with important reductions in delirium, duration of mechanical ventilation, and improved physical function at hospital discharge [
20]. Despite this, only about 25% of all ICU patients receive early therapy [
21]. A number of important barriers, both real and perceived, to implementing early rehabilitation at the patient (for example, delirium, hemodynamic instability), provider (for example, staff discomfort, decreased awareness about the importance of early mobility), and institutional (for example, lack of facilities, personnel, equipment) levels have been identified [
21,
22]. Commonly cited reason for not receiving therapy include oversedation or coma, lack of available rehabilitation staff, and some potentially avoidable including inappropriate vascular access positions, conflict with another planned procedure, and poor sedation management and agitation [
21]. While simply pairing physical therapy sessions with sedative interruption may enhance the delivery of early rehabilitation, ultimately, overcoming these barriers will require the creation of an ICU culture that prioritizes early rehabilitation through interdisciplinary coordination, communication, and teamwork. Educational strategies focused on the complications of oversedation (for example, bed rest/immobility, delirium) and its effects on both the short-term and long-term outcomes (for example, ICUAW, neurocognitive/neuropsychiatric morbidity) may help to facilitate culture change. These elements are essential in ensuring the successful and sustained implementation of such a complex intervention. Finally, the barriers, facilitators, and efficacy of early rehabilitation have been evaluated primarily in medical ICU patients; the applicability of these practices in other ICUs (for example, neurologic, trauma, pediatric) require exploration in future clinical trials.