ICU Early Mobilization: A Twelve-Month Cohort with Structured Eight-Level Progression Protocol: Mobility Trajectories, Ventilator-Free Outcomes, and Functional Recovery in Three Hundred and Forty-Eight ICU Patients

Abstract

ICU-acquired weakness affects approximately 25-50% of mechanically ventilated patients and contributes substantially to post-ICU functional impairment, long-term disability, and post-ICU syndrome. Early mobilization programmes initiating structured exercise and activity progression within the first 24-72 hours of ICU admission have demonstrated benefit across multiple international trials and observational cohorts. We undertook a 12-month prospective cohort study of 348 ICU patients enrolled in a structured 8-level mobility progression protocol. Mobility achievement cascaded through levels: 100% achieved level 1 (passive range of motion), 86% level 2, 71% level 3, 57% level 4 (standing/transferring), 43% level 5 (marching), and 34% level 6 (independent walking). Time to first out-of-bed mobilization was strongly correlated with 6-minute walk distance at discharge (r = -0.58). High mobility achievement (level 4+) was associated with superior outcomes: 28-day ventilator-free survival 87% versus 52% in low-mobility patients. Strongest predictors of poor functional recovery included failure to mobilise beyond level 1, delayed first mobilization, extended ICU stay, prolonged mechanical ventilation, elderly age, pre-ICU frailty, ICU-acquired weakness, and prolonged neuromuscular blockade. High mobility achievement and structured post-ICU rehabilitation were strongly protective.

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