Elsevier

Critical Care Clinics

Volume 23, Issue 1, January 2007, Pages 35-53
Critical Care Clinics

Safety Issues That Should Be Considered When Mobilizing Critically Ill Patients

https://doi.org/10.1016/j.ccc.2006.11.005Get rights and content

Mobilization is often used by physiotherapists for managing critically ill patients with the aim of treatment including improving respiratory function, level of consciousness, functional ability, and psychological well being, and reducing the adverse effects of immobility. In addition, mobilization may decrease the duration of mechanical ventilation and length of ICU or hospital stay. This article provides ICU practitioners with comprehensive guidelines that can be used to assess the safety of mobilizing critically ill patients. The main safety factors that should be addressed include intrinsic factors related to the patient (eg, medical background, cardiovascular and respiratory reserve, and hematological considerations) and factors extrinsic to the patient (eg, patient attachments, environment, and staffing).

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

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