N
euromuscular complications
after critical illness are common
and can be severe and
long lasting (1–5). Patients
in the intensive care unit (ICU) are exposed
frequently to prolonged immobilization
(6–8), which plays an important
role in ICU-acquired neuromuscular
complications (9). Since World War II,
the harms of bed rest and the benefits of
early mobilization of hospitalized patients
have been recognized (10 –12).
More recently, a meta-analysis of 39 randomized
trials examining the effect of bed
rest on 15 medical conditions and procedures
demonstrated that bed rest did not
have benefit and may be harmful (13). As
a consequence of these developments,
there is growing interest in physical medicine
and rehabilitation for critically ill
patients with early introduction of therapies
immediately after physiologic stabilization,
typically within days of ICU admission
(14). To facilitate the delivery of
these therapies, it is important to understand
the potential benefits of introducing
physical medicine and rehabilitationrelated
technology into the ICU setting
including both standard equipment used
for physical medicine and rehabilitation
outside of the ICU, and technology custom-designed
for the unique requirements
of the ICU patient and environment.
Our objective is to describe three
technologies relevant to early physical
medicine and rehabilitation in critically
ill patients: neuromuscular electrical
stimulation, cycle ergometry, and technological
aids and equipment for ambulating
mechanically ventilated patients.