Building a Protocol to Guide Mobility in the ICU

Abstract

Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving through the use of a standardized mobility protocol. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.

The ABCDEF Bundle in Critical Care

“…54 Physical therapy has shown to be feasible, safe, even in the most complicated patients receiving the most advanced medical therapies (e.g., continuous renal replacement therapy, extracorporeal cardiopulmonary support). 62,63 Early activity can be done without increases in usual ICU staffing and with a low risk (<1%) of complications. 64 Studying patients early in the their course of mechanical ventilation (<3 days), Schweickert et al showed that a daily SAT combined with physical and occupational therapy, versus SAT alone, resulted in an improved return to independent functional status at hospital discharge, shorter duration of ICU-delirium, higher survival, and more days breathing without assistance.…”

“…The close collaboration and coordination with medicine, nursing, and physical therapists is fundamental for an efficacy and safe strategy. 62 This is particularly important because the burden of illness affects not only the patient but his or her family or other caregivers as well. 54 …”

A Multidisciplinary Approach to Early Mobilization of Patients With Burns

“…On the basis of this literature review, an early mobility protocol 15 was developed and then further refined for use in patients with burns. "Bed rest" was frequently used as a standard order postoperatively and on admission for all patients.…”

Mobilizing Patients Along the Continuum of Critical Care

“…[4][5][6][7][8][9][10] In 2007, Morris and colleagues evaluated the feasibility, safety, and outcomes associated with a ''mobility team.'' Seven days per week, a physical therapist, critical care nurse, and nursing assistant utilized a protocol for mobilization and criteria for limiting therapy.…”