It is widely recognized that the intensive care unit (ICU) is a different environment than those in which pulmonary rehabilitation (PR) services are performed. Pulmonary rehabilitation usually involves patients with chronic stable disease, who are most often treated as outpatients, while the intensive care unit is occupied by critically ill patients who have multiple dynamic medical or surgical problems. However, some patients admitted to the ICU also suffer from body deconditioning, neuropathy, myopathy, body weakness, increased length of ICU stay, prolonged ventilatory support, delayed weaning, and prolonged post-ICU pulmonary rehabilitation (Schweickert & Hall, 2007 ). MacIntyre pointed out that approximately 40% of ICU patients receive ventilatory support due to acute illnesses complicating chronic illnesses, and the frequency of mechanical ventilation also appears to be increasing (MacIntyre et al., 2005). Additionally, some patients who require prolonged mechanical ventilation become dependent on the ventilator. In the ICU, the need for pulmonary rehabilitation has become clear for all ventilated or non-ventilated patients. Initiating pulmonary rehabilitation in the intensive care unit (ICU) is an important tool to optimize resource utilization, prevent and treat some of the complications of the ICU, and to facilitate, improve long-term recovery, and reduce dependency of the patient from the mechanical ventilator. In this article I will review strategies for starting pulmonary rehabilitation in the ICU. Definition “Pulmonary rehabilitation is an evidence-based, multidisciplinary, comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have reduced activities of daily living. Integrated into individualized patient treatment, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce healthcare costs through stabilization or reversal of systemic manifestations of disease” (Carlin, 2009; L. Nici et al., 2006). This definition focuses on an important number of factors that can influence patient health and healthcare resources. These factors are the multidisciplinary approach, individualized patient treatment and attention to physical, social and health costs (Ries, 2008). The Purpose of Pulmonary Rehabilitation All patients with stable chronic lung disease who are disabled by respiratory disease are candidates for pulmonary rehabilitation ( Ries, 2008 ). The intensive care unit (ICU) is an extremely specialized, busy, and expensive area compared to the outpatient pulmonary rehabilitation program. However, critically ill patients admitted to the intensive care unit (ICU) often suffer from severe manifestations of deconditioning and immobility. The causes of admission to intensive care unit (ICU) are multiple and the