Safety Issues That Should Be Considered When Mobilizing Critically Ill Patients
Section snippets
Medical background and current condition
Prior to mobilization, the patient's medical background should be reviewed in terms of his or her past medical history (see Fig. 1), as this can provide ICU practitioners with information that can help identify how well that patient is likely to tolerate mobilization [1]. In particular, it can indicate in what way the patient's reserve may be limited and therefore the signs and symptoms that particularly need to be monitored during the mobilization treatment. For example, if a critically ill
External factors
In addition to the intrinsic patient-related factors already discussed, there are numerous factors extrinsic to the patient that should be reviewed before mobilizing critically ill patients, including patient attachments, work environment, staffing considerations, and patient consent (see Fig. 1) [1].
Selecting the mobilization intervention
A major consideration when considering the safety of mobilizing critically ill patients is the selection of the mobilization intervention, in terms of the mode of mobilization and its intensity, duration, and frequency (see Fig. 1) [1]. A general safety tip when mobilizing critically ill patients is that it is far safer to increase the intensity of mobilization slowly and progressively as each treatment is tolerated, rather than losing ground if too much is tried too soon.
There is no published
Discussion
This article has provided guidelines for ICU practitioners to assist in clinical decision making when deciding whether to mobilize critically ill patients and when assessing how well the mobilization intervention is being tolerated. As noted earlier, because of a lack of data, these guidelines are not based primarily on evidence from clinical research. Instead, they rely on general exercise and physiological principles, and the author's clinical experience. In view of this fact, it is stressed
Summary
This article provides comprehensive guidelines for ICU practitioners that can be used when assessing the safety of mobilizing critically ill patients. Given a lack of clinical data, these guidelines are based primarily on physiological principles and the author's clinical experience. The main safety factors that are covered include intrinsic factors related to the patient (eg, medical background, cardiovascular and respiratory reserve, and hematological considerations) and factors extrinsic to
References (13)
- et al.
Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients
Arch Phys Med Rehabil
(2004) Physiotherapy in intensive care. Towards an evidence-based practice
Chest
(2000)- et al.
Effect of routine intensive care interactions on metabolic rate
Chest
(1984) Preventing the ITU syndrome or how not to torture an ITU patient! Part 2
Intensive Crit Care Nurs
(1995)- et al.
Safety aspects of mobilising acutely ill inpatients
Physiother Theory Pract
(2003) - et al.
The safety of mobilisation and its effect on hemodynamic and respiratory status of intensive care patients
Physiother Theory Pract
(2004)
Cited by (120)
Key Exercise Concepts in the Rehabilitation from Severe Burns
2023, Physical Medicine and Rehabilitation Clinics of North AmericaFactors associated with early mobilization among colorectal cancer patients after surgery: A cross-sectional study
2023, European Journal of Oncology NursingEarly Mobilization in People With Acute Cardiovascular Disease
2021, Canadian Journal of CardiologyCitation Excerpt :In addition, the benefit of EM may accrue in the postdischarge period, and longer-term outcomes should be collected in future studies. When mobilizing people with acute CV disease, there are distinct considerations, such as an increased risk of triggering arrhythmias or exacerbating coronary ischemia.24 Patients with acute CV often require strict bedrest due to unstable arrhythmias, decompensated HF, active coronary ischemia, and after invasive cardiac interventions.
Exercise interventions are delayed in critically ill patients: a cohort study in an Australian tertiary intensive care unit
2020, Physiotherapy (United Kingdom)