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

Carol L Hodgson, Kathy Stiller, Dale M Needham, Claire J Tipping, Megan Harrold, Claire E Baldwin, Scott Bradley, Sue Berney, Lawrence R Caruana, Doug Elliott, Margot Green, Kimberley Haines, Alisa M Higgins, Kirsi-Maija Kaukonen, Isabel Anne Leditschke, Marc R Nickels, Jennifer Paratz, Shane Patman, Elizabeth H Skinner, Paul J Young, Jennifer M Zanni, Linda Denehy, Steven A Webb, Carol L Hodgson, Kathy Stiller, Dale M Needham, Claire J Tipping, Megan Harrold, Claire E Baldwin, Scott Bradley, Sue Berney, Lawrence R Caruana, Doug Elliott, Margot Green, Kimberley Haines, Alisa M Higgins, Kirsi-Maija Kaukonen, Isabel Anne Leditschke, Marc R Nickels, Jennifer Paratz, Shane Patman, Elizabeth H Skinner, Paul J Young, Jennifer M Zanni, Linda Denehy, Steven A Webb

Abstract

Introduction: The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients.

Methods: A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients.

Results: Safety 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.

Conclusion: Consensus 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.

Figures

Figure 1
Figure 1
Color coding definitions.
Figure 2
Figure 2
Respiratory safety considerations. PEEP, positive end-expiratory pressure.
Figure 3
Figure 3
Cardiovascular safety considerations.
Figure 4
Figure 4
Neurological safety considerations. RASS, Richmond Agitation Assessment Scale; CAM-ICU, confusion assessment method for the ICU.
Figure 5
Figure 5
Medical, surgical and other safety considerations.

References

    1. Lee SM, Schneider SM, Feiveson AH, Macias BR, Smith SM, Watenpaugh DE, Hargens AR. WISE-2005: Countermeasures to prevent muscle deconditioning during bed rest in women. J Appl Physiol (1985) 2014;116:654–667. doi: 10.1152/japplphysiol.00590.2013.
    1. Lee SM, Moore AD, Everett ME, Stenger MB, Platts SH. Aerobic exercise deconditioning and countermeasures during bed rest. Aviat Space Environ Med. 2010;81:52–63. doi: 10.3357/ASEM.2474.2010.
    1. Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest. 2000;118:1801–1813. doi: 10.1378/chest.118.6.1801.
    1. Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144:825–847. doi: 10.1378/chest.12-2930.
    1. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007;23:35–53. doi: 10.1016/j.ccc.2006.11.005.
    1. Zafiropoulos B, Alison JA, McCarren B. Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient. Aust J Physiother. 2004;50:95–100. doi: 10.1016/S0004-9514(14)60101-X.
    1. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, Brower RG, Fan E. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91:536–542. doi: 10.1016/j.apmr.2010.01.002.
    1. Winkelman C, Johnson KD, Hejal R, Gordon NH, Rowbottom J, Daly J, Peereboom K, Levine AD. Examining the positive effects of exercise in intubated adults in ICU: a prospective repeated measures clinical study. Intensive Crit Care Nurs. 2012;28:307–318. doi: 10.1016/j.iccn.2012.02.007.
    1. Berney S, Harrold M, Webb S, Seppelt IM, Patman S, Thomas P, Denehy L. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013;15:260–265.
    1. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, Kaltwasser A, Mende H, Rothaug O, Schuchhardt D, Schwabbauer N, Needham DM. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42:1178–1186. doi: 10.1097/CCM.0000000000000149.
    1. Chang MY, Chang LY, Huang YC, Lin KM, Cheng CH. Chair-sitting exercise intervention does not improve respiratory muscle function in mechanically ventilated intensive care unit patients. Respir Care. 2011;56:1533–1538. doi: 10.4187/respcare.00938.
    1. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, Hermans G, Decramer M, Gosselink R. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37:2499–2505. doi: 10.1097/CCM.0b013e3181a38937.
    1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238–2243. doi: 10.1097/CCM.0b013e318180b90e.
    1. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–1882. doi: 10.1016/S0140-6736(09)60658-9.
    1. Chiang LL, Wang LY, Wu CP, Wu HD, Wu YT. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther. 2006;86:1271–1281. doi: 10.2522/ptj.20050036.
    1. Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, Gough K, Hoorn SV, Morris ME, Berney S. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care. 2013;17:R156. doi: 10.1186/cc12835.
    1. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012;23:5–13.
    1. Pinheiro AR, Christofoletti G. Motor physical therapy in hospitalized patients in an intensive care unit: a systematic review. Rev Bras Ter Intensiva. 2012;24:188–196. doi: 10.1590/S0103-507X2012000200016.
    1. Choi J, Tasota FJ, Hoffman LA. Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of the literature. Biol Res Nurs. 2008;10:21–33. doi: 10.1177/1099800408319055.
    1. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013;94:551–561. doi: 10.1016/j.apmr.2012.10.023.
    1. Thomas AJ. Physiotherapy led early rehabilitation of the patient with critical illness. Phys Ther Rev. 2011;16:46–57. doi: 10.1179/1743288X10Y.0000000022.
    1. Thomas AJ. Exercise intervention in the critical care unit – what is the evidence? Phys Ther Rev. 2009;14:50–59. doi: 10.1179/174328809X405900.
    1. Bassett RD, Vollman KM, Brandwene L, Murray T. Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit Care Nurs. 2012;28:88–97. doi: 10.1016/j.iccn.2011.12.001.
    1. Devlin JW, Pohlman AS. Everybody, every day: an “awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility” culture is feasible in your ICU. Crit Care Med. 2014;42:1280–1281. doi: 10.1097/CCM.0000000000000199.
    1. Stiller K, Phillips A. Safety aspects of mobilising acutely ill inpatients. Physiother Theory Pract. 2003;19:239–257. doi: 10.1080/09593980390246751.
    1. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, Schonhofer B, Stiller K, van de Leur H, Vincent JL. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008;34:1188–1199. doi: 10.1007/s00134-008-1026-7.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi