The most appropriate management is early mobilization with progressive physical activity as tolerated starting now. Disabling weakness and motor function impairments are common in ICU survivors and can last up to 5 years following critical illness. Traditionally, patients in the ICU were believed to be too ill to participate in significant physical activity, and any attempt at full mobilization and exercise was reserved until more aggressive therapies were withdrawn or the acute illness had resolved. This was especially true of patients on mechanical ventilation and vasopressors. In many cases, only passive range of motion exercises were provided in the ICU until the patient was believed to be appropriate for mobilization and increased amounts of active physical activity. However, studies have shown that exercise and physical therapy are the only interventions that have a significant effect on decreasing weakness and motor function deficits associated with critical illness. Additionally, it has been demonstrated that patients on ventilators and low-level vasopressors may safely participate in a progressive mobility program once stability is established.

Early mobilization is defined as patient mobilization (such as sitting up in bed and dangling feet over the edge of the bed) within 48 hours of admission to the ICU. Once the patient is awake and interactive, more aggressive bed exercises can be done. If these activities are tolerated without instability, the patient should be assessed for the next level of activity. Early mobilization, along with careful attention to management of pain, agitation, and delirium, has been shown to reduce ICU and hospital length of stay, shorten return to independent functional status, and improve survival. Waiting for discontinuation of vasopressors or extubation is not appropriate because these may not occur for a significant period of time, in which substantial deconditioning may develop.