Effectiveness of Early Mobilization and Bed Positioning in the Management of Muscle Weakness in Critically Ill People Under Invasive Mechanical Ventilation in Intensive Care: A Systematic Review of Intervention Literature Protocol.

Abstract

<b>Background</b>: Post Intensive Care Syndrome (PICS) is a set of physical, cognitive, and mental health symptoms that arise following intensive care (ICU) hospitalization. Regarding physical changes, muscle weakness is highlighted, potentially leading to functional impairments during and after hospitalization. Multidisciplinary guidelines recommend early mobilization, a rehabilitation intervention, as a strategy to prevent ICU-acquired muscle weakness and reduce functionality impairments. <b>Objective</b>: This study aims to evaluate the effectiveness of early mobilization and positioning interventions to prevent or minimize ICU-acquired weakness in critically ill patients under invasive mechanical ventilation (IMV). <b>Methods</b>: A systematic review of effectiveness will be conducted following Cochrane recommendations. Searches will be made in MEDLINE (via PubMed), CINAHL, Scopus, and Web of Science. Eligible studies will include randomized controlled trials on the functional management of muscle weakness, muscle strength, and ICU-acquired muscle weakness in adults (≥18 years) who have undergone IMV. Eligible interventions (and comparators) include any manual mobilization and positioning strategy or the use of medical devices. Two reviewers will independently select studies, extract data using a piloted tool and assess bias with the RoB 2 tool. If appropriate, a meta-analysis will be conducted, pooling standardized mean differences using a random-effects model. <b>Results</b>: This review included primary experimental studies manipulating at least one variable, control group studies, or randomized trials comparing early intervention protocols, programs, or plans with standard care or existing approaches in the ICU. <b>Conclusions</b>: This review will provide meaningful comparisons of different mobilization and positioning strategies, evaluating their impact on muscle strength and functionality in critically ill patients. Systematic Review Registration: PROSPERO CRD4202348091.