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Vol. 48. Issue 4.
Pages 211-219 (April 2024)
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Vol. 48. Issue 4.
Pages 211-219 (April 2024)
Original article
Efficacy of the “Start to move” protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial
Eficacia del protocolo Start to move en funcionalidad, DA-UCI y delirio: ensayo clínico aleatorizado
Sebastián Sotoa,
Corresponding author

Corresponding author.
, Rodrigo Adasmec,d, Paulina Vivancob,d, Paola Figueroad
a Unidad del Paciente Crítico, Hospital Félix Bulnes, Cerro Navia, Santiago, Chile
b Unidad del Paciente Crítico, Hospital de Urgencia Asistencia Pública, Estación Central, Santiago, Chile
c Equipo de Terapia Respiratoria, Hospital Clínico Red Salud Christus-UC, Chile
d Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
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Figures (1)
Tables (3)
Table 1. Comparison of sociodemographic characteristics between the conventional treatment group and the “Start to move” group.
Table 2. Before and in hospital comparison of functionality, muscle strength and delirium between conventional treatment and the “Start to move” protocol.
Table 3. Results of clinical variables and secondary outcomes between conventional treatment and the “Start to move” protocol.
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To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days.


randomized controlled clinical trial.


Intensive Care Unit.


Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation.


Start to move protocol and conventional treatment.

Main variables of interest

Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, number, NCT05053724.


69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the “Start to move” group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the “conventional treatment” group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the “Start to move” group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the “Start to move” group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension.


The application of the “Start to move” protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.

Intensive Care Unit
Early mobilization
ICU-acquired weakness
Mechanical ventilation

Evaluar la eficacia del protocoloStart to move comparado con tratamiento convencional en sujetos mayores de 15 años hospitalizados en UCI sobre una mejoría en funcionalidad, disminución de debilidad adquirida en UCI (DAUCI), incidencia de delirio, días de ventilación mecánica (VM), estadía en UCI y mortalidad a los 28 días.


Ensayo clínico controlado aleatorizado.


Unidad de paciente crítico.


Incluye adultos mayores a 15 años con VMI mayor a 48 horas, asignación aleatoria.


Protocolo “Start to move” y tratamiento convencional.

Variables de interés principales

Se analizó funcionalidad, incidencia DAUCI, incidencia delirio, días VM, estadía UCI y mortalidad-28 días, número, NCT05053724.


69 sujetos fueron ingresados al estudio, 33 al grupoStart to move y 36 a tratamiento convencional, comparables clínico y sociodemograficamente. En grupo Start to move la incidencia DAUCI al egreso de UCI fue de 35,7% vs 80,7% grupo tratamiento convencional (p=0,001). La funcionalidad (FSS-ICU) al egreso UCI corresponde a 26 vs 17 puntos a favor del grupo Start to move (p=0,001). La diferencia en Barthel al egreso UCI fue de 20% a favor del grupo Start to move (p=0,006). No hubo diferencias significativas en incidencia de delirio, días de VM, estadía UCI y mortalidad-28 días. El estudio no reportó eventos adversos ni suspensión de protocolo.


La aplicación del protocol Start to move en UCI se asoció reducción en la incidencia DAUCI, aumento en funcionalidad y menor caída en puntaje Barthel al egreso.

Palabras clave:
Unidad de cuidados intensivos
Movilización temprana
Terapia física
Debilidad adquirida en la UCI
Ventilación mecánica


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