The Task Force reviewed and discussed the available literature on the effectiveness of physiotherapy for acute and chronic critically ill adult patients. Evidence from randomized controlled trials or meta-analyses was limited and most of the recommendations were level C (evidence from uncontrolled or nonrandomized trials, or from observational studies) and D (expert opinion). However, the following evidence-based targets for physiotherapy were identified: deconditioning, impaired airway clearance, atelectasis, intubation avoidance, and weaning failure. Discrepancies and lack of data on the efficacy of physiotherapy in clinical trials support the need to identify guidelines for physiotherapy assessments, in particular to identify patient characteristics that enable treatments to be prescribed and modified on an individual basis. There is a need to standardize pathways for clinical decision-making and education, to define the professional profile of physiotherapists, and increase the awareness of the benefits of prevention and treatment of immobility and deconditioning for critically ill adult patients.

IntroductionThe aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients.MethodsA systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients.ResultsSafety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations.ConclusionConsensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events.

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Study design: Prospective, observational. Objectives: To investigate the prevalence of orthostatic hypotension (OH), its associated signs and symptoms, and the resulting limitation to treatment during initial physiotherapy treatments involving mobilisation for patients with an acute spinal cord injury (SCI). Setting: Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, Adelaide, South Australia. Methods: Fourteen of 17 consecutive patients admitted with an acute SCI completed the study. Non-invasive measurement of systolic and diastolic blood pressure (BP), heart rate and percutaneous oxygen saturation were recorded during a 10-min baseline period with the patient resting in supine, and then at 1-min intervals for the ®rst 10 min of physiotherapy treatments that involved mobilisation (ie sitting or standing). Following cessation of the treatment and return to the supine position, further measurements were made immediately and following 5 min of rest. Visual signs and patient reported symptoms of OH and any perceived limitation to therapy were also recorded. The study period comprised the ®rst 10 physiotherapy treatments that involved mobilisation. Results: BP changes indicative of OH occurred during 73.6% of mobilisation treatments. Of these treatments, accompanying signs and symptoms of OH were noted on 58.9% of occasions and were perceived as limiting treatment on 43.2% of occasions. Patients with tetraplegia had a higher prevalence of OH and a greater fall in BP than patients with paraplegia, irrespective of whether their lesion was complete or incomplete. Conclusion: Blood pressure changes indicative of OH and accompanying signs and symptoms of OH are a common occurrence during the physiotherapy mobilisation of patients with an acute SCI. Spinal Cord (2000) 38, 741 ± 747

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