Rehabilitation in the intensive care unit: Where are we and what are we aiming for?

Much interest has been paid to the implementation of early rehabilitation within the intensive care unit (ICU). With muscle mass losses of 2% for each day of inactivity (Fazzini et al., 2023), delays to the initiation of rehabilitation increases the likelihood of patients experiencing significant physical and non-physical morbidity. There remains a lack of clarity on what ‘early’ really means, with previous studies of early rehabilitation demonstrating the time to first mobilise ranging from 1 to 13 days (Schweickert et al., 2009, Schaller et al., 2016, McWilliams et al., 2021). Due to the heterogeneity of patients admitted to ICU, from a variety of clinical specialities, with a range of comorbidities and pre-existing health states, the answer becomes more complex than a simple time-point. As recently demonstrated by the TEAM trial (Hodgson et al., 2022), too strong a focus on ‘starting early’ with the singular aim of achieving the highest mobility level for the longest duration possible, potentially without the correct clinical context, may tip the scales towards risk over clinical benefit. Instead, it is essential the initiation of rehabilitation is based on consideration of physiological stability, which for some patients may well not occur within the first week or even two of their ICU admission (McWilliams et al, 2021).