Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults

Abstract

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.

Assessment of functional status in the ICU: instruments used in Brazilian settings

“…Improved functional status is a clinical outcome that has already been evidenced by a physical therapy program in the ICU (31). A highlight in this context has been ICU early mobilization programs, which are proven feasible, safe and bene icial for patients (32,33,34).…”

Validez y confiabilidad de las escalas de evaluación funcional en pacientes críticamente enfermos. Revisión sistemática

“…Al momento de la evaluación los sujetos de estudio debían encontrarse vigiles y cooperadores, en condiciones de estabilidad respiratoria y hemodinámica, y sin contraindicaciones para movilizarse en cama 34 .…”

Should Early Mobilization Be Routine in Mechanically Ventilated Patients?

“…These parameters include the ability to follow commands, stable ventilator settings, and hemodynamic stability. 14 Because early mobilization has provided benefits in the ICU setting, a continuation of the therapy after transfer out of the ICU seems a logical step. However, the impact of this remains unknown because most studies on early mobilization have concentrated on the ICU setting and have not continued the therapy to the floor.…”

“…14 These recommendations are presented as a series of color-coded green, yellow, and red situations (Fig. 2).…”