Patients in the intensive care unit (ICU) could be the paradigm of the management of bed rest via mobilization. They are often sedated, critical/frail patients, with obvious difficulty in changing position, sitting or walking. Immobilization in complex patients in the ICU, together with systemic inflammation, is a strong independent risk factor for the development of intensive care unit-acquired weakness (ICUAW) [9].

Evidence indicates that functionally significant joint limitations are shown by more than a third of patients admitted to ICU for over 2 weeks.

It is noteworthy that enough damage to create the basis for a decubitus ulcer is done after as little as 2 h of immobility. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture) and internal factors (e.g., fever, malnutrition, anemia, and endothelial dysfunction).

Although a few years ago, early physical rehabilitation of critically ill patients was considered unsafe, in the last decade growing literature has shown the safety and feasibility of mobilizing ICU patients to prevent impairments, adverse events, in-hospital infections, and functional limitations [10].

In order to address these aspects, components of the ABCDE bundle include: Awaken from sedation, Breathe independently without a ventilator, Choice of sedation, Delirium management, and Early mobilization [11].

While preliminary data regarding early mobilization of ICU patients has been shown to be safe, feasible, and beneficial, in one multicenter, observational Italian study, postural changes and early mobilization were prescribed in about two thirds of the cases, suggesting that these treatments are not yet widely practiced [12].