Safety criteria to start early mobilization in intensive care units. Systematic review

Abstract

Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.

Score of Perme: Analysis of Clinical Destroys the High or Death the Intensive Care Unit

“…Despite knowledge of the deleterious effects of bed rest in multiple body systems (23)(24)(25)(26) the ICU turns out to be a complicated and difficult environment to mobilize critically ill patients. There are several catheters and monitors to support life, use of sedation to reduce energy expenditure, sleep disorders, electrolyte imbalance, and mild hemodynamic state, which are factors that limit mobilization, thus contributing to the patient's staying a rest period (27)(28)(29).…”

“…Muscle weakness acquired in the ICU is a consequence commonly found in patients restricted to the bed, especially in those who used invasive ventilatory support. Studies on the effect of inactivity on skeletal muscle strength have shown a decrease of 1% to 1.5% per day in patients restricted to the bed, and in patients in MV this decline may be more significant, ranging from 5% to 6% per day (28,30,31).…”

“…The mobilization within the ICU described in recent studies has been shown to be safe when performed in a standardized and systematic way. For it to occur effectively, all staff involved in care must participate and understand its importance (28,32).…”

Construct validity of the Functional Status Score for the Intensive Care Unit: a prospective observational study using actigraphy in mechanically-ventilated patients

“…The first measurement of the FSS-ICU and MRC-SS were performed within 24 hours of awakening. Before each measurement, clinical stability was assessed using cardiovascular, respiratory, neurological and orthopaedic safety criteria [42] so patients could sit on the edge of the bed and at least three FSS-ICU activities could be assessed, which are requirements for assessing the FSS-ICU total score. The FSS-ICU and MRC-SS were assessed again when ICU discharge was decided and within 24 hours of leaving the unit.…”

The role of physiotherapy in intensive care units: a critical review

“…it is believed that these techniques combined with MHi and endotracheal suctioning enhance airway clearance [16]. Mechanical chest wall percussion may be safe to use in secretion mobilization; it improves the ratio between partial pressure of oxygen in arterial blood (Pao 2 ) and Fio 2 (Pao 2 /Fio 2 ) and reduces the need for oxygen [17]. Chest wall squeezing during expiration enhances airway clearance during endotracheal suctioning [18].…”