Nurse-led early mobilization and ICU-acquired weakness in mechanically ventilated adults: a retrospective before-after cohort study

Introduction ICU-acquired weakness (ICU-AW) is a frequent complication of critical illness, and real-world evidence on nurse-led early mobilization (EM) in Asian ICUs remains limited. Methods We conducted a single-center, retrospective before-after cohort study of invasively ventilated adults admitted during usual-care ( n = 153) and nurse-led EM ( n = 164) periods. ICU-AW, defined as a Medical Research Council (MRC) sum score <48, was assessed among evaluable ICU survivors ( n = 266); ICU death made volitional strength testing non-evaluable and was addressed in a death-or-ICU-AW composite sensitivity analysis. The primary model estimated the association between protocol implementation and ICU-AW after adjustment for baseline confounders; post-exposure care processes were examined separately. Results ICU-AW occurred in 60/129 (46.5%) usual-care survivors and 40/137 (29.2%) nurse-led EM survivors (crude absolute risk difference 17.3 percentage points [95% CI 5.8–28.8] among evaluable survivors; crude OR 0.474, 95% CI 0.286–0.786). The baseline-adjusted OR was 0.436 (95% CI 0.248–0.766; P = 0.004). Morbidity-related secondary outcomes favored nurse-led EM, including lower delirium incidence (41.2% vs. 22.6%; OR 0.416), shorter ICU stay (median 11 vs. 8 days), and higher discharge Barthel Index (70 vs. 85). No statistically significant ICU mortality difference was detected (15.7% vs. 16.5%; OR 1.059, 95% CI 0.581–1.93), but the study was not powered to exclude clinically important mortality effects. Discussion Nurse-led EM implementation was associated with lower odds of ICU-AW and improved morbidity outcomes. Because exposure was assigned by historical period, residual and secular confounding remain important limitations, and confirmation in a randomized or stepped-wedge implementation study is warranted.