Revisión sistemática de recomendaciones actualizadas en la rehabilitación temprana para adultos en la unidad de cuidados intensivos

Abstract

La rehabilitación temprana en pacientes críticos se ha consolidado como una práctica médica segura, eficaz y asequible, con el potencial de reducir las secuelas del síndrome de debilidad adquirida en la Unidad de Cuidados Intensivos (DAUCI), así como de mitigar los efectos adversos de la hospitalización prolongada y del síndrome post-cuidados intensivos. La implementación de intervenciones rehabilitadoras dentro de las primeras 24 a 72 horas tras el ingreso a la UCI ofrece beneficios significativos a nivel respiratorio, cardiovascular y musculoesquelético. Asimismo, contribuye a la reducción del tiempo en ventilación mecánica y de la estancia hospitalaria. Estos efectos tienen implicaciones favorables a largo plazo en la funcionalidad del paciente, la percepción de calidad de vida, los costos para el sistema de salud y el retorno a las actividades laborales. Esta investigación tiene como objetivo profundizar en los desafíos asociados con la protocolización de programas de rehabilitación temprana en la UCI, con énfasis en la movilización temprana. Además, subraya la importancia de un enfoque colaborativo y multidisciplinario para superar las barreras existentes y optimizar los resultados clínicos en pacientes críticamente enfermos.

Background: Early rehabilitation in critically ill patients has proven to be a safe and effective, intervention, with the potential to reduce the sequelae of ICU-acquired weakness and mitigate the adverse effects of prolonged hospitalization. Implementing rehabilitation within the first 24 to 72 hours of ICU admission provides significant benefits at the respiratory, cardiovascular, and musculoskeletal levels, and contributes to shorter durations of mechanical ventilation and hospital stays. These effects have long-term implications for patient functionality, quality of life, healthcare costs, and return-to-work outcomes. Objectives: This study aims to deepen understanding of the challenges involved in initiating and standardizing early rehabilitation protocols in the ICU, with a specific focus on early mobilization. It will emphasize the importance of a multidisciplinary approach to overcome these barriers and optimize clinical outcomes for critically ill patients. Methods: This qualitative systematic review aims to identify current recommendations for early rehabilitation in adult ICU patients. The study follows PRISMA-ScR 2020 guidelines and includes primary studies published between 2015 and 2025. Secondary sources (systematic reviews) and tertiary sources (clinical guidelines, institutional protocols) were also reviewed to provide a comprehensive perspective. Searches were conducted in PubMed, Embase, and Scopus using predefined keywords in both English and Spanish, combined with Boolean operators. A snowball strategy was used to identify additional relevant studies through citation tracking. Results: A total of 34 studies were included in the review. Initial database searches yielded approximately 169 titles and abstracts. After screening, 80 articles were selected for full-text review, of which 29 met the inclusion and exclusion criteria. An additional 5 studies were identified through citation and reference tracking, resulting in a total of 34 included studies. Conclusions: Early rehabilitation in the ICU is a key intervention to promote functional recovery and improve quality of life in critically ill patients. The evidence suggests that initiating mobilization within 72 hours of ICU admission-- particularly in hemodynamically stable patients--can reduce the duration of mechanical ventilation and hospital length of stay. Interventions such as active mobilization, early physiotherapy, cycling therapy, and neuromuscular electrical stimulation (NMES) show promising results, although heterogeneity in study designs and outcome measures limits comparability. Early mobilization is generally safe, though adverse events such as desaturation and arrhythmias have been reported, highlighting the importance of individualized risk assessment. Common barriers include limited trained personnel, logistical constraints, and the absence of standardized protocols. This review underscores the need for clearer definitions of contraindications, greater inclusion of underrepresented regions, and more rigorous studies to develop adaptable, evidence-based clinical guidelines.