Early Active Mobilization in Critically Ill Patients on Vasopressor or Inotropic Support: A Prospective Cohort Study

Objectives: The objective of this study was to assess the safety of early active mobilization (EAM) in critically ill adults receiving vasopressor or inotropic support. Material and Methods: We conducted a prospective cohort study in a 10-bed intensive care unit in Colombia between September 2023 and November 2024. Eligible patients were adults ≥18 years with vasopressor or inotropic support for ≥2 h, stable dosing for ≥30 min, and the ability to follow simple commands (Glasgow Coma Scale score ≥13 or Richmond Agitation-Sedation Scale −2 to +1). Exclusion criteria were inability to perform active or assisted movement, severe hypoperfusion (lactate >6 mmol/L), prone positioning, multiple-organ failure, uncontrolled bleeding, post-cardiac arrest status, or recent cerebral/cardiac ischemic events. Interventions followed the frequency, intensity, time, and type of exercise principle and included EAM activities based on individual clinical assessment. We evaluated patients using standardized scales and monitored cardiorespiratory responses. The primary outcome was safety, defined as the absence of adverse events during or immediately after EAM. Results: We included 24 patients (mean age 66.5 ± 13.5 years, 62.5% male). Primary diagnoses were septic shock (29%) and cardiogenic shock (29%). Norepinephrine was required in 75% of patients (median dose 0.13 μg/kg/min). During EAM, 50% received supplemental oxygen and 25% required mechanical ventilation. Mobilization activities included sitting at the edge of the bed (46%), standing (29%), sitting in a chair (17%), and remaining semi-Fowler (8%). No adverse events occurred during any session. Only minimal, clinically non-significant increases in diastolic blood pressure ( P < 0.05) and mean arterial pressure ( P < 0.05) were observed. Conclusions: EAM in patients appears safe in critically ill adults receiving vasopressor or inotropic support when guided by structured assessment protocols. These findings challenge current restrictive mobility practices and suggest potential benefits for patient recovery. Larger studies are needed to confirm safety and establish evidence-based mobilization guidelines for hemodynamically supported patients.