Safety of Early Mobilisation in Critically Ill Patients Under Unusual High-Risk Conditions: A Latin American Case Series.

BACKGROUND: Early mobilisation (EM) in the intensive care unit (ICU) is associated with a reduced incidence of intensive care unit-acquired weakness, shorter hospital length of stay and improved functional outcomes. However, most of the available evidence derives from patient populations at low risk of safety-related adverse events. This limits the generalisability of its benefits to more complex clinical scenarios, such as the concurrent administration of blood products, continuous parenteral nutrition, antiarrhythmic infusions or multiple haemodynamic pharmacological support. Consequently, evidence regarding the safety of EM in these contexts remains scarce. This case series is aimed at describing the safety of EM under unusual and high-risk clinical conditions, an area that remains underexplored in the international literature. CASE PRESENTATION: We describe six critically ill patients presenting with conditions traditionally considered high risk for EM. Two patients were receiving active transfusion of blood products: a 70-year-old woman under invasive mechanical ventilation and a 69-year-old man with upper gastrointestinal bleeding and moderate anaemia; both performed active exercises during red blood cell transfusion. Two additional patients were receiving continuous enteral nutrition: a 42-year-old man requiring invasive mechanical ventilation and a 76-year-old woman; both undertook active exercises during nutritional administration. The fifth case involved a 65-year-old woman with atrial flutter treated with an amiodarone infusion. The sixth case was a 65-year-old woman with cardiomyopathy and suspected sepsis, requiring triple haemodynamic pharmacological support with noradrenaline, vasopressin and dobutamine. Exercise prescription was individualised according to intensity, type and duration, based on the dosing determined by the attending physiotherapist. All interventions were conducted under continuous monitoring. No adverse events or complications related to EM or invasive devices were observed. CONCLUSIONS: EM can be safely implemented in critically ill patients, even under conditions traditionally considered high risk, provided that strict criteria for clinical stability and continuous monitoring are applied. These findings provide relevant preliminary evidence supporting the feasibility of active rehabilitation in the ICU and open new avenues for research aimed at defining specific safety criteria for EM in high-risk populations.