NURS 8710 Week 10 Literature Review Draft Example

Where the Baseline Sits: A Draft Literature Review on Getting Ventilated ICU Patients Moving and What It Does for Their Recovery

Student Name

College of Nursing, Walden University

NURS 8710: Doctoral Seminar I

Instructor Name

Month Day, Year

Where the Baseline Sits: A Draft Literature Review on Getting Ventilated ICU Patients Moving and What It Does for Their Recovery

Question and Boundaries

Patients who receive mechanical ventilation in intensive care often leave the hospital weaker than they entered it, and many have lasting limits on walking and daily activities. Early active mobilization, getting patients to participate in exercise, sitting, standing and walking while still ventilated, has been proposed as a way to reduce that loss. The review's question is whether getting ventilated ICU patients moving early, set against usual care or a smaller amount of the same thing, leaves them better able to function when they go home or later, and what harms come with it.

The review covers adults receiving invasive ventilation, active rather than passive interventions begun in the ICU and studies with a comparison group published from 2006 onward. It does not cover rehabilitation that begins after ICU discharge, passive or electrical interventions alone, or children.

Method

PubMed and Europe PMC were searched on October 4, 2026, using three concept blocks for ventilated or critically ill adults, mobilization and rehabilitation, and physical function, with limits for adults, publication years 2006 to 2026 and trial or cohort designs. The two databases yielded 245 and 429 records respectively; 186 appeared in both, so 488 unique records remained. ClinicalTrials.gov returned 99 completed registered studies, kept separately to check for unpublished trials. The strategy was tested against eleven studies known to be relevant and revised until it retrieved all of them. CINAHL is still to be searched.

Inclusion rules were defined for population, intervention, comparison, outcome and design and piloted by two readers on eight records, who agreed on six; the two disagreements arose from abstracts lacking information and were resolved by moving such records to full-text review. Full-text screening of the remaining records is under way. This draft synthesizes the eleven studies confirmed eligible to date, one prospective cohort and ten randomized trials, and a flow diagram following PRISMA 2020 will be added when screening is complete (Page et al., 2021). Each study was appraised with design-appropriate criteria, and appraisal is reported within the synthesis, where a study's weakness bears on the finding being used. An evidence table is given in the appendix.

Feasibility and Safety

The evidence is consistent that mobilizing ventilated adults is feasible. A mobility team of a nurse, a nursing assistant and a physical therapist in a medical ICU raised the proportion of patients receiving therapy from 47% to 80% and cut the median wait before a patient first left the bed from 11 days to 5, without events during sessions and without added cost (Morris et al., 2008). In a pilot trial across five ICUs, two thirds of patients in the mobilization arm walked while in intensive care, against just over a third of controls, with no adverse events (Hodgson et al., 2016). When therapists worked with patients during their daily sedation holds, one serious event, a desaturation, occurred in 498 sessions, and therapy was stopped for instability in 4% of sessions (Schweickert et al., 2009).

Safety becomes less clear in larger trials and at higher doses. A trial in surgical ICUs reported more adverse events in the mobilization arm, none of them serious, and a numerically higher rate of death before discharge that the trial was not designed to test (Schaller et al., 2016). The largest trial reported adverse events potentially due to mobilization, mainly arrhythmias, blood pressure changes and desaturation, in 9.2% of the intervention arm against 4.1% of usual care, and more serious adverse events (TEAM Study Investigators, 2022). A consensus panel has agreed thresholds for oxygenation, heart rate, blood pressure and neurological state within which mobilizing ventilated patients is acceptable, and found that an endotracheal tube is not by itself a reason to withhold it (Hodgson et al., 2014). The safety evidence therefore supports mobilization within those criteria, while warning that risk may rise as the amount of mobilization increases. A limitation runs through this theme. The small trials logged only what happened while a session was running, whereas the large trial logged anything plausibly linked to mobilization at any point in the stay, so the two kinds of rate cannot be set side by side.

Function at Discharge When the Baseline Is Low

The clearest benefits appear at or before hospital discharge, in trials whose control groups received little structured mobilization. When therapy started within the first days of ventilation, 59% of patients were independent in daily activities and walking at discharge, compared with 35% of controls (Schweickert et al., 2009). A mobilization algorithm used across five surgical ICUs lifted the highest activity level patients achieved and left them more mobile when they went home (Schaller et al., 2016). A daily bedside cycling session added to standard therapy improved walking distance, quadriceps strength and self-reported physical function at hospital discharge, though not at ICU discharge (Burtin et al., 2009). A pilot trial in patients with sepsis, by contrast, found no difference in a function index at ICU discharge (Kayambu et al., 2015).

Two cautions qualify this theme. The cycling trial's outcomes reflect survivors, and its abstract does not report how many sessions were active rather than passive, which matters for this review's question. The trial of therapy during sedation interruption enrolled only patients who were functionally independent before admission, so its result may not apply to frailer patients. A published systematic review reached a similar conclusion about the short term, reporting stronger muscles when patients left the ICU and better odds of walking unaided when they left hospital (Tipping et al., 2017).

Higher Doses Where Patients Already Move

Three trials compared a higher dose of mobilization or rehabilitation with a lower one, and none found that the higher dose improved longer-term physical function. An intensive physical therapy program delivering about 408 minutes over up to four weeks, against about 86 minutes in the standard program, left physical performance scores the same as the standard program's at every follow-up from one to six months (Moss et al., 2016). A target of 90 minutes of rehabilitation a day against 30 minutes, with medians of 161 and 86 minutes delivered in the ICU, produced no difference in the physical component of a quality of life measure at six months (Wright et al., 2018). In the largest trial, raising active mobilization from a mean of 8.8 to 20.8 minutes a day left the six-month total of days at home and alive unchanged while adverse events rose (TEAM Study Investigators, 2022).

The common feature is the comparison. In each of these trials the control arm already received a meaningful amount of therapy, so the trials tested more against some, not some against none. Read beside the trials in the previous theme, the pattern suggests that benefit rises when patients move from little mobilization to some and flattens thereafter. That reading has a weakness: the dose trials also differed from the earlier trials in population, outcome and timing of measurement, and with this number of studies the effect of dose cannot be isolated. The dose trials also have their own limits. One had outcome data at six months for fewer than half of those randomized, with deaths and losses to follow-up both substantial (Wright et al., 2018), and another had six-month data for 60% of patients (Moss et al., 2016).

Function After Discharge

Whether early gains persist is the least settled question in the review. Trials that measured function six months or more after discharge mostly found no difference: a program continuing from the ICU to the ward and outpatient care found no difference in walking distance at twelve months, though exploratory analyses suggested faster improvement (Denehy et al., 2013), and the dose trials found none at six months. Two trials found partial benefit at six months: patients with sepsis rated their own physical function higher (Kayambu et al., 2015) and in a performance battery and physical function score after daily standardized rehabilitation, which did not shorten hospital stay, its primary outcome (Morris et al., 2016).

Few studies measured function both at discharge and months later, so the set cannot say whether early benefits fade as usual care patients catch up or whether the later trials never produced early benefits to begin with. Loss to follow-up, which is common in this population because many patients die or are too unwell to attend testing, weakens all the long-term findings.

Gap

The review settles more than expected and leaves a narrower gap. All eleven studies took place in academic centers or research networks, and most delivered mobilization through therapists or dedicated teams. Not one of them evaluated a program run chiefly by the bedside nursing staff, with no specialist team and no therapist on hand each day, in a unit whose usual practice leaves ventilated patients largely in bed. Because the strongest benefits came from trials with low-mobilization comparison groups, a low-baseline unit is exactly where mobilization might help most, yet it is the setting the evidence has not reached. The gap is one of transferability: whether nurses on their own can lift such a unit to the amount of activity the positive trials achieved, without the safety record slipping.

Conclusion

Across the studies that have tried it, mobilizing ventilated patients has proved workable, and serious harm within agreed safety limits has been uncommon. It improves function at discharge when the alternative is little mobilization. Where patients already move a fair amount, extra sessions have not helped months later and may bring more adverse events. For a unit considering mobilization, the evidence points to a question about its own practice before any question about intensity: how much mobilization do its ventilated patients receive now? Where the answer is very little, the review supports increasing reach within safety criteria; where it is already substantial, the review does not support doing more.

Appendix: Evidence Table

Table 1 summarizes the studies synthesized. A fuller table with intervention dose, comparison and appraisal notes was prepared earlier in the review.

Table 1

Studies Included in the Draft Review

References

Burtin, C., Clerckx, B., Robbeets, C., Ferdinande, P., Langer, D., Troosters, T., Hermans, G., Decramer, M., & Gosselink, R. (2009). Early exercise in critically ill patients enhances short-term functional recovery. Critical Care Medicine, 37(9), 2499-2505. https://doi.org/10.1097/CCM.0b013e3181a38937

Denehy, L., Skinner, E. H., Edbrooke, L., Haines, K., Warrillow, S., Hawthorne, G., Gough, K., Vander Hoorn, S., Morris, M. E., & Berney, S. (2013). Exercise rehabilitation for patients with critical illness: A randomized controlled trial with 12 months of follow-up. Critical Care, 17(4), Article R156. https://doi.org/10.1186/cc12835

Hodgson, C. L., Bailey, M., Bellomo, R., Berney, S., Buhr, H., Denehy, L., Gabbe, B., Harrold, M., Higgins, A., Iwashyna, T. J., Papworth, R., Parke, R., Patman, S., Presneill, J., Saxena, M., Skinner, E., Tipping, C., Young, P., & Webb, S. (2016). A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Critical Care Medicine, 44(6), 1145-1152. https://doi.org/10.1097/CCM.0000000000001643

Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., Bradley, S., Berney, S., Caruana, L. R., Elliott, D., Green, M., Haines, K., Higgins, A. M., Kaukonen, K.-M., Leditschke, I. A., Nickels, M. R., Paratz, J., Patman, S., Skinner, E. H., . . . Webb, S. A. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), Article 658. https://doi.org/10.1186/s13054-014-0658-y

Kayambu, G., Boots, R., & Paratz, J. (2015). Early physical rehabilitation in intensive care patients with sepsis syndromes: A pilot randomised controlled trial. Intensive Care Medicine, 41(5), 865-874. https://doi.org/10.1007/s00134-015-3763-8

Morris, P. E., Berry, M. J., Files, D. C., Thompson, J. C., Hauser, J., Flores, L., Dhar, S., Chmelo, E., Lovato, J., Case, L. D., Bakhru, R. N., Sarwal, A., Parry, S. M., Campbell, P., Mote, A., Winkelman, C., Hite, R. D., Nicklas, B., Chatterjee, A., & Young, M. P. (2016). Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: A randomized clinical trial. JAMA, 315(24), 2694-2702. https://doi.org/10.1001/jama.2016.7201

Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., Ross, A., Anderson, L., Baker, S., Sanchez, M., Penley, L., Howard, A., Dixon, L., Leach, S., Small, R., Hite, R. D., & Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238-2243. https://doi.org/10.1097/CCM.0b013e318180b90e

Moss, M., Nordon-Craft, A., Malone, D., Van Pelt, D., Frankel, S. K., Warner, M. L., Kriekels, W., McNulty, M., Fairclough, D. L., & Schenkman, M. (2016). A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. American Journal of Respiratory and Critical Care Medicine, 193(10), 1101-1110. https://doi.org/10.1164/rccm.201505-1039OC

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71

Schaller, S. J., Anstey, M., Blobner, M., Edrich, T., Grabitz, S. D., Gradwohl-Matis, I., Heim, M., Houle, T., Kurth, T., Latronico, N., Lee, J., Meyer, M. J., Peponis, T., Talmor, D., Velmahos, G. C., Waak, K., Walz, J. M., Zafonte, R., & Eikermann, M. (2016). Early, goal-directed mobilisation in the surgical intensive care unit: A randomised controlled trial. The Lancet, 388(10052), 1377-1388. https://doi.org/10.1016/S0140-6736(16)31637-3

Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. The Lancet, 373(9678), 1874-1882. https://doi.org/10.1016/S0140-6736(09)60658-9

TEAM Study Investigators and the ANZICS Clinical Trials Group. (2022). Early active mobilization during mechanical ventilation in the ICU. New England Journal of Medicine, 387(19), 1747-1758. https://doi.org/10.1056/NEJMoa2209083

Tipping, C. J., Harrold, M., Holland, A., Romero, L., Nisbet, T., & Hodgson, C. L. (2017). The effects of active mobilisation and rehabilitation in ICU on mortality and function: A systematic review. Intensive Care Medicine, 43(2), 171-183. https://doi.org/10.1007/s00134-016-4612-0

Wright, S. E., Thomas, K., Watson, G., Baker, C., Bryant, A., Chadwick, T. J., Shen, J., Wood, R., Wilkinson, J., Mansfield, L., Stafford, V., Wade, C., Furneval, J., Henderson, A., Hugill, K., Howard, P., Roy, A., Bonner, S., & Baudouin, S. (2018). Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): A multicentre, parallel-group, randomised controlled trial. Thorax, 73(3), 213-221. https://doi.org/10.1136/thoraxjnl-2016-209858