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To evaluate whether early mobilisation can reduce the incidence of delirium in critically ill patients and to assess the methodological quality of published studies.
Methods
Three electronic databases, PubMed, Embase and the Cochrane Library, were searched for relevant studies published up to 2 March 2024. Articles were screened independently by two reviewers, based on inclusion and exclusion criteria, and a meta-analysis was performed using RevMan 5.3 software with a random-effects model.
Results
A total of 18 studies (intervention group: 1794 participants, control group: 2129 participants) were included in the systematic review, with 18 studies included in the meta-analysis. Early mobilisation was found to reduce the risk of delirium in critically ill populations, with a pooled odds ratio of 0.65 (95% confidence interval [CI] 0.49–0.86; P = 0.003; I2 = 59%). Additionally, two studies found that early mobilisation did not change the duration of delirium in critically ill populations, with a pooled mean difference of −1.53 (95% CI −3.48 to 0.41; P = 0.12; I2 = 37%). Subgroup analysis revealed that early mobilisation maintained its preventive effect on delirium in the before/after intervention studies, studies published before 2018 and studies with a moderate methodological rating.
Conclusion
As a nonpharmacological intervention, early mobilisation may help reduce the risk of delirium and shorten its duration in critically ill patients compared with standard treatment and may potentially become a novel strategy for delirium prevention in future intensive care unit settings.
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Introduction
Delirium is a common complication in critically ill patients, with a systematic review of studies from North and South America, Europe and Asia reporting a pooled prevalence of 31.8% in patients receiving ventilated and nonventilated treatment in the intensive care unit (ICU). The prevalence of delirium is generally 50–70% in patients receiving mechanically ventilated care, and, accordingly, is of considerable clinical importance [1‐4]. Delirium refers to a clinical state that is characterised by a combination of features defined by diagnostic systems such as the DSM‑5 [5]. In critically ill patients, delirium typically manifests as fluctuations in consciousness, abnormal behaviour and cognitive impairment [6]. Although the exact mechanism of delirium remains unclear, research shows that it may be related to many factors, including inflammatory reactions, neurotransmitter imbalance, brain injury and drug use. Additionally, the brain network theory suggests that delirium is associated with disrupted functional connectivity and network efficiency in the brain. This theory posits that hypoactive delirium, in particular, involves changes in brain network dynamics, which can be observed through functional connectivity and network analysis [7]. In critically ill patients in particular, prolonged bed rest, systemic inflammatory responses caused by illness and the use of sedative medications may aggravate the occurrence of delirium, which can be relieved through drug and nondrug intervention [8, 9]. Delirium can have catastrophic clinical consequences for patients [10]. First, it significantly increases the length of hospitalisation time and medical expenses [11]. Second, it leads to failed weaning from mechanical ventilation, muscle atrophy and malnutrition, thereby increasing the risk of ventilator-associated pneumonia and deep vein thrombosis. Additionally, the condition causes anxiety and depression and can even increase the risk of long-term cognitive impairment, severely affecting the quality of life and rehabilitation process of patients [12].
In addition to traditional pharmacological treatments, nonpharmacological interventions for preventing delirium offer a promising approach. Among these nonpharmacological interventions, early mobilisation may be an effective approach. Early mobilisation aims to promote patients’ activity and cognitive function, reduce bed rest time and improve muscle strength and endurance, thereby enhancing their rehabilitation process [13]. The definition of early mobilisation encompasses a range of activities, including in-bed exercises, bedside sitting, walking training and stationary cycling [14]. These activities are provided to patients individually or as part of a bundle. The preventive effect of early mobilisation on delirium is worth exploring. Studies have suggested that early mobilisation can reduce the risk of delirium in critically ill patients [15, 16]. By reducing bed rest time and improving muscle strength and cognitive function, early mobilisation helps to maintain patients’ clarity of consciousness and perception, thereby reducing the incidence of delirium [17]. Additionally, early mobilisation can improve patients’ psychological status and reduce the occurrence of anxiety and depression, further lowering the risk of delirium. However, the effects of early mobilisation on delirium prevention are inconsistent. Although some studies support the effectiveness of this approach, others have failed to confirm its preventive effect on delirium [18]. This can be attributed to differences in study design, sample size and intervention measures.
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Although a few meta-analyses have explored the preventive effects of early rehabilitation on delirium in critically ill patients, they include limitations [19, 20]. These meta-analyses are often influenced by factors such as a limited search scope, an insufficient number of included studies and inconsistent methodological quality, leading to ineffective coverage and comprehensive analysis of all the relevant studies in this field. Additionally, because of the rapid development in medical research, new studies continue to emerge, necessitating an up-to-date meta-analysis on the effects of early mobilisation on delirium prevention in critically ill patients. This study aims to address this research gap by exploring whether early mobilisation, either alone or as part of a preventive bundle, can improve the risk or duration of delirium in critically ill patients compared with standard treatment.
Methods
This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines recommended by the Cochrane Collaboration [21].
Search strategy and study selection
A systematic search was performed using three electronic databases, PubMed, Embase and the Cochrane Library, from inception to 2 March 2024, without language restrictions. The search strategy combined MeSH terms or Emtree indexing with free-text terms, primarily including ‘delirium’, ‘rehabilitation’, ‘exercise’, ‘early mobilisation’, ‘critical illness’ and ‘ICU’. Free-text terms were searched for in the title and abstract/keyword fields. Details of the search strategy are presented in Table 1. Additionally, the reference lists of relevant studies and reviews were manually searched to identify additional potential records. The retrieved records were imported into EndNote X9.3.3 (Clarivate Analytics, London, UK) for duplicate removal using software and manual screening thereafter. Subsequently, the titles and abstracts of potentially relevant electronic records were screened independently by two reviewers to create a list for full-text reading. Finally, studies that met the inclusion and exclusion criteria were determined according to predefined criteria. When discrepancies occurred between the two reviewers, a senior investigator made the final decision.
Table 1
Search strategy for electronic databases
Databases
Search terms
PubMed (n = 544)
(“Delirium”[Title/Abstract] OR “confusion”[Title/Abstract] OR “icu psychosis”[Title/Abstract] OR “postoperative psychosis”[Title/Abstract] OR “acute encephalopathy”[Title/Abstract] OR “agitation”[Title/Abstract] OR “icu delirium”[Title/Abstract] OR “Delirium”[MeSH Terms]) AND (“Rehabilitation”[MeSH Terms] OR “Exercise”[MeSH Terms] OR “mobilization”[Title/Abstract] OR “early mobilization”[Title/Abstract] OR “Rehabilitation”[Title/Abstract] OR “Exercise”[Title/Abstract] OR “ambulation”[Title/Abstract] OR “walking”[Title/Abstract] OR “cycling”[Title/Abstract]) AND (“Critical Care”[MeSH Terms] OR “Critical Illness”[MeSH Terms] OR “Intensive Care Units”[MeSH Terms] OR “Critical Illness”[Title/Abstract] OR “Critical Care”[Title/Abstract] OR “intensive care unit”[Title/Abstract] OR “ICU”[Title/Abstract])
Embase (n = 1148)
(‘delirium’/exp OR ‘delirium’:ab,ti OR ‘confusion’:ab,ti OR ‘icu psychosis’:ab,ti OR ‘postoperative psychosis’:ab,ti OR ‘acute encephalopathy’:ab,ti OR ‘agitation’:ab,ti OR ‘icu delirium’:ab,ti) AND (‘mobilization’/exp OR ‘rehabilitation’/exp OR ‘exercise’/exp OR ‘mobilization′:ab,ti OR ‘early mobilziation’:ab,ti OR ‘walking’:ab,ti OR ‘cycling’:ab,ti OR ‘ambulation’:ab,ti) AND ((‘critical care’/exp OR ‘critical illness’/exp) AND ‘intensive care unit’/exp OR ‘intensive care unit’:ab,ti OR ‘critical illness’:ab,ti OR ‘critical care’:ab,ti OR ‘icu’:ab,ti)
Cochrane Library (n = 252)
((MeSH descriptor: [Delirium] explode all trees) OR (delirium OR confusion OR icu psychosis OR postoperative psychosis OR acute encephalopathy OR agitation OR icu delirium):ti,ab,kw) AND ((MeSH descriptor: [Rehabilitation] explode all trees) OR (MeSH descriptor: [Exercise] explode all trees) OR (mobilization OR early mobilization OR rehabilitation OR exercise OR ambulation OR walking OR cycling):ti,ab,kw) AND ((MeSH descriptor: [Critical Care] explode all trees) OR (MeSH descriptor: [Critical Illness] explode all trees) OR (MeSH descriptor: [Intensive Care Units] explode all trees) OR (critical care OR critical illness OR intensive care unit OR ICU):ti,ab,kw)
Inclusion and exclusion criteria
Based on the widely applied PICOS (patient, intervention, comparison, outcome, and study design) principle, the inclusion criteria for this study were set as follows: 1) critically ill patients or those admitted to the ICU; 2) intervention groups receiving early mobilisation intervention; 3) the presence of a control group receiving positive or negative control treatments; 4) treatment outcome indicators including delirium incidence or duration; and 5) study designs comprising randomised controlled trials (RCTs), before/after intervention studies (BAISs) or quality improvement studies. Exclusion criteria included the following: 1) duplicate studies; 2) irrelevant study types, such as case reports, literature reviews and conference abstracts; and 3) studies with incomplete data or unclear assessment methods.
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The term ‘delirium’ refers to a clinical state characterised by a combination of features that are defined by diagnostic systems such as the DSM‑5. Delirium, according to the DSM‑5, is defined if criteria A–E are fulfilled [5]: A) a disturbance in attention (i.e. a reduced ability to direct, focus, sustain and shift attention) and awareness (reduced orientation to the environment); B) the disturbance, which develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of the day; C) an additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability or perception); D) the disturbances in criteria A and C are not explained by another pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as a coma; E) there is evidence from the patient’s history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (e.g. because of a drug abuse or medication) or exposure to a toxin, or is the result of multiple aetiologies. This is a preferred term.
Data extraction and risk-of-bias assessment
Upon finalising the included studies, two reviewers independently extracted data from the included studies using a pre-designed form. The extracted data mainly included the study author, publication year, country, study design, sample size, intervention and control group settings, ICU type, mechanical ventilation settings, delirium assessment methods, personnel and characteristics of the included population. Additionally, a bias risk assessment of RCTs was conducted following the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1) and evaluated aspects such as random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of the outcome assessment (detection bias), completeness of the outcome data (attrition bias), selective reporting (reporting bias) and other sources of bias. The risk-of-bias assessment for non-RCTs was conducted using the ROBINS‑I tool [22], which has 7 domains: bias due to confounding, bias in the selection of participants for the study, bias in the classification of interventions, bias due to deviations from intended interventions, bias due to missing data, bias in the measurement of outcomes and bias in the selection of the reported result. Each domain is graded as low, moderate, serious or critical.
Statistical analysis
Statistical analysis was conducted using RevMan 5.3 software (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark). For dichotomous variables, odds ratios (ORs) with their 95% confidence intervals (CIs), were calculated as the effect-size statistic. For continuous variables, mean differences (MDs) were used. Heterogeneity among the included studies was assessed using the Cochran Q test combined with the I2 statistic. When heterogeneity was low (P > 0.1 or I2 < 50%), a fixed-effects model was employed for meta-analysis; otherwise, a random-effects model was used. The significance level was set at α = 0.05, and publication bias was assessed using funnel plots. Subgroup analyses were conducted based on the study design, publication year and risk of bias to evaluate the effect of early mobilisation on delirium under different conditions. Sensitivity analyses were also performed to evaluate the influence of individual studies on the summary results.
Results
Based on the search strategy, a total of 1944 electronic records were obtained, with 544 from PubMed, 1148 from Embase, 252 from the Cochrane Library and an additional 2 records retrieved through other resources. After removing 693 duplicate records, the remaining 1253 records were screened based on titles and abstracts. Full-text reading was conducted for 32 potentially relevant articles, resulting in the exclusion of 14 articles because of unreported outcome settings (n = 7), unclear assessment (n = 4) and irrelevant study types (n = 3). Finally, 18 articles were included in the systematic review, 1 of which was excluded from the meta-analysis because of unavailable data. The detailed literature screening process is shown in Fig. 1.
A total of 18 articles [18, 23‐39] were included in the systematic review, and their basic characteristics are summarised in Table 2. Among them, 7 studies were conducted in North America, and there were 7 RCTs, 10 BAISs and 1 quality improvement study. The intervention group comprised 1794 participants, whereas the control group included 2129 participants. Various intervention methods were used in the included studies, with 4 studies adopting the ABCDE bundle method and 14 adopting conventional control methods (Supplementary Table S1). Thirteen studies reported patients mainly from mixed ICUs, whereas the remaining studies reported patients from medical, trauma, neurological and emergency ICUs. Various delirium assessment methods were employed, including the confusion assessment method (CAM), DRS, and ICDSC scores, with the CAM-ICU being the most frequently used (66.7%).
ICU intensive care unit, RCT randomized controlled trial, CAM Confusion Assessment Method, DRS Delirium Rating Scale, USA United States of America, BAIS before-after intervention study, ABCDE Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility, FES functional electrical stimulation, ICDSC Intensive Care Delirium Screening Checklist, CADPS Cornell Assessment for Delirium in Pediatrics Score, QI quality improvement
The characteristics of patients included in the studies are presented in Table 3. The mean age ranged from 34.3–82.9 years in the intervention group and from 28.3–84.3 years in the control group. The proportion of men ranged from 41.7–73.1% and from 36.8–70.7%, respectively. The APACHE II scores ranged from 10–26.6 and from 11–26.3, respectively, and the delirium rates ranged from 0–95% and from 0–92.8%, respectively.
APACHE II Acute Physiology and Chronic Health Evaluation II, NR not reported
Risk-of-bias assessment
In terms of RCTs, detailed information regarding the risk of bias is shown in Fig. 2. The majority of studies (85.7%) clearly reported methods for random sequence generation, although some studies reflected an unclear risk, caused by allocation concealment and blinding factors. No RCT had incomplete outcome data, obvious selective reporting or other biases. Regarding non-RCTs, detailed information about the risk of bias is shown in Table 4. Most studies (81.8%) were rated as moderate, but 1 study was rated as serious and 1 as critical.
Fig. 2
Methodological quality of randomized controlled trials assessed with the Cochrane Risk of Bias tool
ROBINS‑I risk of bias in nonrandomized studies of interventions tool
Meta-analysis
Data on delirium incidence were reported in 17 studies. After pooling the data, it was found that early mobilisation reduced the risk of delirium in critically ill patients, with a summary OR of 0.65 (95% CI 0.49–0.86; P = 0.003; I2 = 59%). Additionally, data on delirium duration were reported in 2 studies, revealing that early mobilisation did not change the duration of delirium in critically ill patients, with a summary MD of −1.53 (95% CI: −3.48–0.41; P = 0.12; I2 = 37%).
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Subgroup analysis
Subgroup analyses were conducted based on study design, publication year and risk of bias to evaluate the effect of early mobilisation on delirium. The results showed that early mobilisation did not reduce the risk of delirium in the RCTs, although it effectively prevented delirium in the BAISs, with summary ORs of 0.55 (95% CI 0.30–1.04; P = 0.07; I2 = 68%) and 0.68 (95% CI 0.49–0.93; P = 0.02; I2 = 61%), respectively. Furthermore, only one quality-improvement study reported a nonsignificant effect of early mobilisation on delirium (Fig. 3). The results of articles published before 2018 showed that early mobilisation effectively reduced the risk of delirium, but this effect was not significant in articles published after 2018, with summary ORs of 0.49 (95% CI 0.36–0.66; P < 0.001; I2 = 36%) and 0.97 (95% CI 0.70–1.34; P = 0.84; I2 = 36%), respectively (Fig. 4). According to the risk assessment results, early mobilisation significantly prevented delirium only in studies rated as moderate, with a summary OR of 0.65 (95% CI 0.45–0.94; P = 0.02; I2 = 61%; Fig. 5).
Fig. 3
Forest plot of the effect of early mobilisation on prevention of delirium in critically ill patients stratified by study design
After conducting funnel plot analysis for delirium incidence data, it was found that the distribution of results from 17 studies was approximately symmetrical, indicating no significant publication bias (Fig. 6). Furthermore, excluding any single study did not significantly alter the summary results, suggesting a limited influence of individual studies on the overall results.
Fig. 6
Funnel plot of the effect of early mobilisation on prevention of delirium in critically ill patients. SE standard error, OR odds ratio
This meta-analysis synthesised the latest clinical evidence to evaluate the preventive and therapeutic effects of early mobilisation as a nonpharmacological intervention for delirium in critically ill patients and assessed the risk of bias in the included studies. The findings support the brain network theory, which suggests that interventions improving brain connectivity, such as early mobilisation, may reduce the incidence of delirium. Studies utilising encephalography (EEG) have highlighted the importance of maintaining functional connectivity to prevent delirium. Furthermore, Schaller et al. [40] emphasised that early mobilisation should be initiated within the first 72 h of ICU admission to optimise outcomes and minimise the risk of complications. The main findings of this study are as follows: 1) compared with the control group, critically ill patients who received early mobilisation had a significantly reduced risk of delirium, but the treatment did not reduce the duration of the condition; 2) early mobilisation effectively prevented delirium in BAISs but did not reduce the risk of delirium in RCTs; and 3) publication year and study quality partially influenced the effect of early mobilisation on preventing delirium. This study is anticipated to provide evidence-based guidelines for the clinical use of early mobilisation to prevent delirium in critically ill patients and serve as a reference for future research in this area.
The results of this study indicate that the majority of studies support early mobilisation as an intervention to reduce the risk of delirium in critically ill patients. This aligns with the brain network theory, which emphasises the role of functional connectivity in maintaining cognitive function and reducing delirium risk. Early mobilisation may enhance brain network efficiency and connectivity, contributing to its preventive effects on delirium [41]. Additionally, the findings support the updated hypothesis by Maldonado et al. [42], which suggests that addressing neurotransmitter dysregulation, inflammation and neuroendocrine dysregulation can mitigate delirium risk in critically ill patients. Furthermore, according to Schaller et al. [40], early mobilisation protocols, when implemented within the first 72 h of ICU admission, can significantly improve patient outcomes. Additionally, a study conducted by Nydahl et al. [43] highlights the global implementation of delirium assessment protocols and the importance of standardised approaches, including early mobilisation as part of a bundled intervention, to effectively manage and prevent delirium in critically ill patients. However, to translate these findings into clinical practice, it is crucial to consider how early mobilisation can be effectively integrated into standard ICU care protocols. The study results suggest that early mobilisation, particularly when initiated early, can have significant impacts on patient outcomes, such as reducing the incidence of delirium, improving cognitive function, and potentially shortening ICU stays. The evidence points toward early mobilisation as a key nonpharmacological strategy for delirium prevention, which could be incorporated into routine ICU protocols as part of a holistic approach to patient care.
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Despite these promising findings, inconsistencies remain across studies. Differences in study design, sample size, and intervention methods, as well as variations in brain connectivity measures, may contribute to these discrepancies. Moreover, the timing and intensity of early mobilisation interventions, as highlighted by Schaller et al. [40], may influence the outcomes and effectiveness of the intervention. In clinical practice, implementing early mobilisation as a standalone intervention may not always be sufficient, particularly in patients with severe shock, infection, or other complicating factors. In these cases, early mobilisation should be considered part of a broader, multifaceted care bundle that addresses the complex pathophysiology of delirium.
This analysis underscores the importance of early mobilisation in stroke patients, though its effects and optimal timing require further investigation. For instance, a study on very early mobilisation after thrombolysis in acute ischemic stroke patients found no significant improvement in functional outcomes or secondary outcomes within the first 24 h [44]. Similarly, the AVERT trial, which assessed very early mobilisation within 24 h, found no improvement in quality of life at 3 or 12 months compared to usual care. In fact, this study suggested that mobilisation initiated too early might even have detrimental effects, particularly in the short term [45, 46]. Current evidence generally supports starting mobilisation after 24 h, once patients have achieved haemodynamic stability, as this timing is associated with improved functional recovery [47].
The study by Nydahl et al. [43] highlights the need for global standardisation in delirium assessment and management protocols to address inconsistencies in intervention effectiveness. Early rehabilitation, especially early mobilisation, is an essential part of delirium prevention in critically ill patients, yet its effectiveness may vary depending on patient characteristics and the clinical environment. Several studies suggest that early mobilisation, when incorporated into multicomponent intervention bundles, can reduce delirium incidence and duration. For instance, the ABCDEF bundle, which includes early mobility as a key component, has been shown to decrease delirium and ICU stay duration in ICU patients [48]. Additionally, nonpharmacological interventions like exercise and cognitive stimulation, part of structured rehabilitation programs, have demonstrated efficacy in reducing delirium [49]. However, as delirium can be caused by various factors—such as shock, infection and hypoxia—it is crucial to consider a comprehensive approach rather than relying solely on early mobilisation. In cases like stroke patients, reduced movement can lead to poorer cerebral perfusion, increasing the risk of delirium [50]. On the other hand, premature mobilisation in critical conditions like shock might exacerbate hypoperfusion and worsen delirium risk [51]. Network meta-analysis further reinforces the role of multicomponent interventions, including early mobilisation, in delirium prevention, with some combinations like sleep promotion, cognitive stimulation, and early mobilisation proving particularly effective [20]. Therefore, it is essential that early rehabilitation and mobilisation programs be tailored to individual patient needs, ensuring personalised care that considers their specific clinical circumstances.
The results of this study are consistent with previous meta-analyses [19, 20], indicating that early rehabilitation may have a significant effect in preventing delirium in critically ill patients. However, this study offers several novel contributions that differentiate it from earlier research. First, we synthesised the latest research evidence, incorporating studies published up to 2024, which include findings that previous meta-analyses may have missed. By expanding the scope of the evidence base, our analysis provides a more comprehensive and up-to-date confirmation of early mobilisation’s effect on delirium prevention. This ensures that our conclusions are reflective of the most current research, reinforcing the importance of early mobilisation as a key intervention for delirium. Second, our meta-analysis features a more thorough subgroup analysis, allowing for a deeper understanding of the effect of early mobilisation across different clinical scenarios. We explored variations in patient characteristics, study design, and intervention timing, which helped explain the heterogeneity observed in the overall results. This level of granularity offers more nuanced insights into the effectiveness of early mobilisation under specific conditions, such as in before/after intervention studies, or studies conducted prior to 2018. By analysing different patient subgroups, we provide a clearer picture of the mechanisms underlying early rehabilitation and its impact on delirium prevention, thereby offering more precise guidance for clinical practice. Third, this study highlights the time-dependent effect of early mobilisation, showing that the intervention’s efficacy may vary based on evolving knowledge and practices in ICU care. This dynamic perspective contributes a fresh understanding of how early mobilisation protocols can be refined and adapted to improve patient outcomes over time. In summary, while this meta-analysis confirms findings from previous research, it adds novel value by incorporating the latest studies, offering detailed subgroup analyses, and providing insights into the evolving application of early mobilisation in ICU settings. These aspects strengthen the evidence base for early rehabilitation and provide more actionable recommendations for its integration into routine clinical practice.
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Although the results of this study are largely credible, it still includes limitations. First, although most studies did not have a clear high risk of bias, some uncertainty remains, which may have affected the study results to an extent. Second, although we attempted various methods to explain the heterogeneity in the study, the overall results still exhibited significant heterogeneity. This may have been the result of, for example, differences in study design, measurement methods or population characteristics, and further research is needed to explain this. Moreover, how to influence the results if different subgroup analysis methods are adopted remain requires further investigation. Nonetheless, it remains certain that early exercise can reduce the risk of mental illness in critically ill patients. Finally, we will focus on various clinical interferences or the pathophysiological mechanisms of the disease itself that affect the advantage of early exercise. Overall, our conclusions must be validated by additional studies and should be cautiously generalised to clinical practice.
Conclusion
Compared with standard care, as a nonpharmacological intervention, early mobilisation can help to reduce the risk of delirium and decrease its duration in critically ill patients. It holds promise as a novel strategy for preventing delirium in the ICU setting. However, considering the heterogeneity observed in this meta-analysis, further high-quality research is needed to explore this topic in more depth.
Acknowledgements
Special thanks to Professor Chen Bing, The People’s Hospital of Leshan, for supporting the data of this study.
Funding
Not applicable.
Declarations
Conflict of interest
L. Zhou, F. Xie, Y. Zeng, X. Xia, R. Wang, Y. Cai, Y. Lei, F. Xu, X. Li and B. Chen declare that they have no competing interests.
Ethical statement is non-applicable for this study due to the design of a meta-analysis.
The supplement containing this article is not sponsored by industry.
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Kotfis K, Marra A, Ely EW (2018) ICU delirium—a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther 50(2):160–167. https://doi.org/10.5603/AIT.a2018.0011CrossRefPubMed
Krewulak KD, Stelfox HT, Leigh JP, Ely EW, Fiest KM (2018) Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Crit Care Med 46(12):2029–2035. https://doi.org/10.1097/ccm.0000000000003402CrossRefPubMed
Numan T, Slooter AJC, van der Kooi AW et al (2017) Functional connectivity and network analysis during hypoactive delirium and recovery from anesthesia. Clin Neurophysiol 128(6):914–924. https://doi.org/10.1016/j.clinph.2017.02.022CrossRefPubMed
8.
Wilcox ME, Burry L, Englesakis M et al (2024) Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review. Thorax. https://doi.org/10.1136/thorax-2023-220036CrossRefPubMed
Ottens TH, Hermes C, Page V et al (2024) The Delphi delirium management algorithms. A practical tool for clinicians, the result of a modified delphi expert consensus approach. Delirium 2024:10.56392/001c.90652. https://doi.org/10.56392/001c.90652CrossRef
11.
van Lieshout C, Schuit E, Hermes C, Kerrigan M, Frederix GWJ (2022) Hospitalisation costs and health related quality of life in delirious patients: a scoping review. Z Evid Fortbild Qual Gesundhwes 169:28–38. https://doi.org/10.1016/j.zefq.2022.02.001CrossRefPubMed
Hermes C, Ottens T, Knitter P, Hauss O, Bellgardt M, von Dossow V (2022) Delir – beurteilung, vorbeugung und behandlung : aufgabe im interprofessionellen team der Intensivstation [delirium-assessment, prevention and treatment : task in the interprofessional intensive care unit team. Med Klin Intensivmed Notfmed 117(6):479–488. https://doi.org/10.1007/s00063-022-00943-3CrossRefPubMed
14.
TEAM Study Investigators and the ANZICS Clinical Trials Group, Hodgson CL, Bailey M et al (2022) Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 387(19):1747–1758. https://doi.org/10.1056/NEJMoa2209083CrossRef
15.
Hsieh SJ, Otusanya O, Gershengorn HB et al (2019) Staged implementation of awakening and breathing, coordination, delirium monitoring and management, and early mobilization bundle improves patient outcomes and reduces hospital costs. Crit Care Med 47(7):885–893. https://doi.org/10.1097/CCM.0000000000003765CrossRefPubMedPubMedCentral
16.
Shirvani F, Naji SA, Davari E, Sedighi M (2020) Early mobilization reduces delirium after coronary artery bypass graft surgery. Asian Cardiovasc Thorac Ann 28(9):566–571. https://doi.org/10.1177/0218492320947230CrossRefPubMed
Berney S, Hopkins RO, Rose JW et al (2021) Functional electrical stimulation in-bed cycle ergometry in mechanically ventilated patients: a multicentre randomised controlled trial. Thorax 76(7):656–663. https://doi.org/10.1136/thoraxjnl-2020-215093CrossRefPubMed
19.
Nydahl P, Jeitziner MM, Vater V et al (2023) Early mobilisation for prevention and treatment of delirium in critically ill patients: systematic review and meta-analysis. Intensive Crit Care Nurs 74:103334. https://doi.org/10.1016/j.iccn.2022.103334CrossRefPubMed
20.
Matsuura Y, Ohno Y, Toyoshima M, Ueno T (2023) Effects of non-pharmacologic prevention on delirium in critically ill patients: a network meta-analysis. Nurs Crit Care 28(5):727–737. https://doi.org/10.1111/nicc.12780CrossRefPubMed
21.
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700CrossRefPubMedPubMedCentral
Álvarez EA, Garrido MA, Tobar EA et al (2017) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: a pilot randomized clinical trial. J Crit Care 37:85–90. https://doi.org/10.1016/j.jcrc.2016.09.002CrossRefPubMed
24.
Balas MC, Vasilevskis EE, Olsen KM et al (2014) Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med 42(5):1024–1036. https://doi.org/10.1097/CCM.0000000000000129CrossRefPubMedPubMedCentral
25.
Bounds M, Kram S, Speroni KG et al (2016) Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients. Am J Crit Care 25(6):535–544. https://doi.org/10.4037/ajcc2016209CrossRefPubMed
26.
Bryant EA, Tulebaev S, Castillo-Angeles M et al (2019) Frailty identification and care pathway: an interdisciplinary approach to care for older trauma patients. J Am Coll Surg 228(6):852–859.e1. https://doi.org/10.1016/j.jamcollsurg.2019.02.052CrossRefPubMed
Foster J, Kelly M (2013) A pilot study to test the feasibility of a nonpharmacologic intervention for the prevention of delirium in the medical intensive care unit. Clin Nurse Spec 27(5):231–238. https://doi.org/10.1097/NUR.0b013e3182a0b9f9CrossRefPubMed
29.
Frade-Mera MJ, Arias-Rivera S, Zaragoza-García I et al (2022) The impact of ABCDE bundle implementation on patient outcomes: a nationwide cohort study. Nurs Crit Care 27(6):772–783. https://doi.org/10.1111/nicc.12740CrossRefPubMed
Larsen LK, Møller K, Petersen M, Egerod I (2020) Delirium prevalence and prevention in patients with acute brain injury: a prospective before-and-after intervention study. Intensive Crit Care Nurs 59:102816. https://doi.org/10.1016/j.iccn.2020.102816CrossRefPubMed
32.
Lee Y, Kim K, Lim C, Kim JS (2020) Effects of the ABCDE bundle on the prevention of post-intensive care syndrome: a retrospective study. J Adv Nurs 76(2):588–599. https://doi.org/10.1111/jan.14267CrossRefPubMed
33.
Martínez F, Donoso AM, Marquez C, Labarca E (2017) Implementing a Multicomponent intervention to prevent delirium among critically ill patients. Crit Care Nurse 37(6):36–46. https://doi.org/10.4037/ccn2017531CrossRefPubMed
34.
Matsuki R, Kojima N, Watanabe K et al (2020) Impact of a rehabilitation protocol and a dedicated therapist in the intensive care unit on physical function and activities of daily living. Prog Rehabil Med 5:20200027. https://doi.org/10.2490/prm.20200027CrossRefPubMedPubMedCentral
Nydahl P, Günther U, Diers A et al (2020) PROtocol-based MObilizaTION on intensive care units: stepped-wedge, cluster-randomized pilot study (Pro-Motion). Nurs Crit Care 25(6):368–375. https://doi.org/10.1111/nicc.12438CrossRefPubMed
37.
Nydahl P, McWilliams D, Weiler N et al (2022) Mobilization in the evening to prevent delirium: a pilot randomized trial. Nurs Crit Care 27(4):519–527. https://doi.org/10.1111/nicc.12638CrossRefPubMed
38.
Patel J, Baldwin J, Bunting P, Laha S (2014) The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia 69(6):540–549. https://doi.org/10.1111/anae.12638CrossRefPubMed
Schaller SJ, Scheffenbichler FT, Bein T et al (2024) Guideline on positioning and early mobilisation in the critically ill by an expert panel. Intensive Care Med 50(8):1211–1227. https://doi.org/10.1007/s00134-024-07532-2CrossRefPubMed
41.
van der AJ, Ottens TH, Lodema DY et al (2023) Electroencephalography and connectivity in delirium. Tijdschr Psychiatr 65(10):633–636
42.
Maldonado JR (2018) Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry 33(11):1428–1457. https://doi.org/10.1002/gps.4823CrossRefPubMed
Anjos JM, Neto MG, de Araújo Tapparelli Y et al (2023) Efficacy and safety of very early mobilization after thrombolysis in acute ischemic stroke: a randomized clinical trial. J Neurol 270(2):843–850. https://doi.org/10.1007/s00415-022-11411-5CrossRefPubMed
AVERT Trial Collaboration group. (2015) Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 386(9988):46–55. https://doi.org/10.1016/S0140-6736(15)60690-0CrossRef
47.
Mariana de Aquino MJ, Mendes Borges V, Bazan R, Luvizutto JG, Sabrysna Morais Shinosaki J (2023) Early mobilization in acute stroke phase: a systematic review. Top Stroke Rehabil 30(2):157–168. https://doi.org/10.1080/10749357.2021.2008595CrossRef
48.
Sosnowski K, Lin F, Chaboyer W, Ranse K, Heffernan A, Mitchell M (2023) The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: a systematic review and meta-analysis. Int J Nurs Stud 138:104410. https://doi.org/10.1016/j.ijnurstu.2022.104410CrossRefPubMed
49.
Kang J, Cho YS, Lee M, Yun S, Jeong YJ, Won YH et al (2023) Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: a systematic review and meta-analysis. Aust Crit Care 36(4):640–649. https://doi.org/10.1016/j.aucc.2022.04.006CrossRefPubMed
Mart MF, Roberson WS, Salas B, Pandharipande PP, Ely EW (2021) Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med 42(1):112–126. https://doi.org/10.1055/s-0040-17105CrossRefPubMed
Auf mögliche kardiale Auswirkungen postoperativer Schmerzen weist die Subgruppenanalyse des randomisierten kontrollierten HIP-ATTACK-Trials hin. Bei ausgeprägten Schmerzen im Zusammenhang mit einer Hüftoperation stiegen die Troponinspiegel signifikant an – ein Kausalzusammenhang ist damit allerdings noch nicht belegt.
Laut einer Querschnittstudie leiden rund 7% der in Deutschland lebenden über 16-Jährigen unter chronischen Schmerzen, die ihren Alltag stark beeinträchtigen. Außer biologischen scheinen auch psychische und soziale Faktoren mit sogenanntem High-Impact Chronic Pain assoziiert zu sein.
Ob nun Sonogerät, Praxiscomputer oder gar TI-Konnektor: Einfach zum nächsten Wertstoffhof sollten Praxisteams ausgediente Elektrogeräte nicht bringen. Was bei der Entsorgung zu beachten ist. Und wie die Teams sicher sensible Daten auf PC-Festplatte, externem Datenspeicher und TI-Komponenten löschen.
Im Fall einer Sepsis ist eine Körpertemperatur unter 36 °C bei älteren Menschen ein Warnsignal. In einer Studie aus Dänemark war bei Hypothermie, nicht aber bei Fieber das Mortalitätsrisiko deutlich erhöht.
Mit unserem e.Med Abo Anästhesiologie haben Sie jederzeit Zugriff auf aktuelles, praxisnahes Fachwissen – kompakt und einfach verfügbar. Jetzt CME-Punkte bequem online sammeln.
