Efficacy and safety of early mobilization in patients with ARDS: a systematic review and meta-analysis

Objective To evaluate the effect of early mobilization in patients with acute respiratory distress syndrome (ARDS). Methods Computerized searches were conducted in PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, CBM, and VIP databases for randomized controlled trials (RCTs) on early mobilization in ARDS patients. The retrieval period was from the establishment of each database to September 30, 2025. Two reviewers independently assessed the quality of included literature and extracted data in accordance with Cochrane systematic review methodology. Meta-analysis was performed using RevMan 5.4.1 software for eligible studies. Results A total of 7 RCTs were included, consisting of 4 English and 3 Chinese articles. Meta-analysis showed that compared with conventional treatment, early mobilization significantly reduced the incidence of intensive care unit-acquired weakness (ICU-AW) [OR = 0.35, 95% CI (0.19,0.64), P = 0.0006] and delirium [OR = 0.51, 95% CI (0.28,0.91), P = 0.02], shortened the duration of mechanical ventilation [MD = −2.40,95% CI (-2.96,-1.84), P < 0.00001], length of ICU stay [MD = −3.36, 95% CI (−4.21,-2.52), P < 0.00001] and total hospital stay [MD = −2.74,95% CI (-3.49,-1.98), P < 0.00001]. Meanwhile, it improved patients’functional independence score (Barthel Index) [MD = 17.27, 95% CI (11.18, 23.35), P < 0.00001] and decreased the incidence of complications [OR = 0.39, 95% CI (0.17, 0.86), P = 0.02]. All pooled effects were statistically significant. Conclusion Early mobilization yields significant clinical benefits for ARDS patients, improving short-term clinical outcomes and functional recovery. It is worthy of clinical promotion and application. However, multicenter, large-sample, and methodologically standardized RCTs are still needed to further verify its long-term effects and optimal implementation protocols.