Cardiovascular |
Heart rate |
> 40bpm and < 130bpm |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Harris et al.(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.)
|
|
Systolic arterial pressure |
< 180mmHg |
Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) e Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.)
|
|
|
> 90mmHg and < 200mmHg |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) and Bourdin et al.(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.)
|
|
Mean arterial pressure |
> 60mmHg |
Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Segers et al.(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) and Engel et al.(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.)
|
|
|
> 60mmHg and < 110mmHg |
Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) and Mah et al.(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.)
|
|
|
> 65mmHg < 110mmHg |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) and Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.)
|
|
Hemodynamic stability |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Engel et al.,(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) Mah et al.,(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.) Dickinson et al.(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) and Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.)
|
|
No vasoactive drugs |
-- |
Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Ronnebaum et al.,(4444 Ronnebaum JA, Weir JP, Hilsabeck TA. Earlier mobilization decreases the length of stay in the intensive care unit. J Acute Care Phys Ther. 2012;3(2):204-10.) Thomsen et al.(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) and Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.)
|
|
No increase of vasopressor dose in the past 2 hours |
-- |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Needham et al.(4646 Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42.) and Balas et al.(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.)
|
|
No myocardial ischemia |
-- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Balas et al.,(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
No arrhythmia |
-- |
Abrams et al.,(2121 Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18(1):R38.) Nava,(3030 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849-54.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Dickinson et al.,(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
No femoral artery catheter |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Timmerman(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.)
|
|
No repetition of antiarrhythmic agent |
-- |
Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Balas et al.(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
Respiratory |
Respiratory rate |
> 5bpm < 40bpm |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) and Olkowski et al.(5151 Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93(2):208-15.)
|
|
|
< 35bpm |
Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.,(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
Peripheral oxygen saturation |
> 88% |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.) and Olkowski et al.(5151 Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93(2):208-15.)
|
|
|
≥ 90% |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Dantas et al.(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) e Médrinal et al.(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.)
|
|
Mechanical ventilation parameters |
FiO2 < 0.6 and/or PEEP < 10cmH2O |
Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Segers et al.,(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) Balas et al.,(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) Wang et al.(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
|
FiO2 ≤ 0.6 and PEEP ≤ 10cmH2O |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Mah et al.,(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.) Dickinson et al.,(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) Thomsen et al.,(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.) and Needham et al.(4646 Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42.)
|
|
Airway protection |
- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.)
|
Neurological |
Intracranial pressure |
Not elevated |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.) and Meyer et al.(5353 Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262.)
|
|
Level of consciousness |
Not in coma |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Thomsen et al.,(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.) and Witcher et al.(5252 Witcher R, Stoerger L, Dzierba AL, Silverstein A, Rosengart A, Brodie D, et al. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation. J Crit Care. 2015;30(2):344-7.)
|
|
|
No agitation |
Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Bourdin et al.(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) and Segers et al.(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.)
|
|
|
Understands and performs commands correctly |
Nava,(3030 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849-54.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Thomsen et al.(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) and Wang et al.(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.)
|
Cardiovascular |
Heart rate |
> 40bpm and < 130bpm |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Harris et al.(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.)
|
|
Systolic arterial pressure |
< 180mmHg |
Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) e Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.)
|
|
|
> 90mmHg and < 200mmHg |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) and Bourdin et al.(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.)
|
|
Mean arterial pressure |
> 60mmHg |
Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Segers et al.(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) and Engel et al.(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.)
|
|
|
> 60mmHg and < 110mmHg |
Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) and Mah et al.(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.)
|
|
|
> 65mmHg < 110mmHg |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) and Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.)
|
|
Hemodynamic stability |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Engel et al.,(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) Mah et al.,(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.) Dickinson et al.(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) and Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.)
|
|
No vasoactive drugs |
-- |
Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Ronnebaum et al.,(4444 Ronnebaum JA, Weir JP, Hilsabeck TA. Earlier mobilization decreases the length of stay in the intensive care unit. J Acute Care Phys Ther. 2012;3(2):204-10.) Thomsen et al.(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) and Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.)
|
|
No increase of vasopressor dose in the past 2 hours |
-- |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Needham et al.(4646 Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42.) and Balas et al.(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.)
|
|
No myocardial ischemia |
-- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Balas et al.,(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
No arrhythmia |
-- |
Abrams et al.,(2121 Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18(1):R38.) Nava,(3030 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849-54.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Dickinson et al.,(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
No femoral artery catheter |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Timmerman(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.)
|
|
No repetition of antiarrhythmic agent |
-- |
Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Balas et al.(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
Respiratory |
Respiratory rate |
> 5bpm < 40bpm |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) and Olkowski et al.(5151 Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93(2):208-15.)
|
|
|
< 35bpm |
Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Wang et al.,(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.) and Drolet et al.,(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
Peripheral oxygen saturation |
> 88% |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dong et al.,(3232 Dong ZH, Yu BX, Sun YB, Fang W, Li L. Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med. 2014;5(1):48-52.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.) and Olkowski et al.(5151 Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93(2):208-15.)
|
|
|
≥ 90% |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Dantas et al.(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) e Médrinal et al.(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.)
|
|
Mechanical ventilation parameters |
FiO2 < 0.6 and/or PEEP < 10cmH2O |
Perme et al.,(1212 Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212-21.) Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.,(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) Segers et al.,(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) Balas et al.,(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) Wang et al.(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
|
FiO2 ≤ 0.6 and PEEP ≤ 10cmH2O |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Mah et al.,(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.) Dickinson et al.,(4242 Dickinson S, Tschannen D, Shever LL. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit? Crit Care Nurs Q. 2013;36(1):127-40.) Thomsen et al.,(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.) and Needham et al.(4646 Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-42.)
|
|
Airway protection |
- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.)
|
Neurological |
Intracranial pressure |
Not elevated |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Brummel et al.,(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.) and Meyer et al.(5353 Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262.)
|
|
Level of consciousness |
Not in coma |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Thomsen et al.,(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.) and Witcher et al.(5252 Witcher R, Stoerger L, Dzierba AL, Silverstein A, Rosengart A, Brodie D, et al. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation. J Crit Care. 2015;30(2):344-7.)
|
|
|
No agitation |
Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Harris et al.,(3434 Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Proc (Bayl Univ Med Cent). 2014;27(3):203-7.) Bourdin et al.(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) and Segers et al.(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.)
|
|
|
Understands and performs commands correctly |
Nava,(3030 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849-54.) Perme et al.,(3535 Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F. Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J. 2013;24(2):12-7.) Bourdin et al.,(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) Thomsen et al.(4545 Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119-24.) and Wang et al.(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.)
|
|
|
Opens eyes in response to verbal stimulus |
Davis et al.,(2424 Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith KA, et al. Mobilization of ventilated older adults. J Geriatr Phys Ther. 2013;36(4):162-8.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Olkowski et al.(5151 Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93(2):208-15.) and Engel et al.(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.)
|
|
|
Responds to verbal stimulus |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Mah et al.(4141 Mah JW, Staff I, Fichandler D, Butler KL. Resource-efficient mobilization programs in the intensive care unit: who stands to win? Am J Surg. 2013;206(4):488-93.) and Bailey et al.(1010 Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139-45.)
|
|
No neurological and/or neuromuscular diseases hindering mobilization |
-- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Segers et al.,(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) Engel et al.,(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) Ronnebaum et al.,(4444 Ronnebaum JA, Weir JP, Hilsabeck TA. Earlier mobilization decreases the length of stay in the intensive care unit. J Acute Care Phys Ther. 2012;3(2):204-10.) Meyer et al.(5353 Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262.) Winkelman et al.(5454 Winkelman C, Higgins PA, Chen YJ. Activity in the chronically critically ill. Dimens Crit Care Nurs. 2005;24(6):281-90.) and Hopkins et al.(5555 Hopkins RO, Miller RR 3rd, Rodriguez L, Spuhler V, Thomsen GE. Physical therapy on the wards after early physical activity and mobility in the intensive care unit. Phys Ther. 2012;92(12):1518-23.)
|
Orthopedic |
No unstable fracture |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Dantas et al.,(3131 Dantas CM, Silva PF, Siqueira FH, Pinto RM, Matias S, Maciel C, et al. Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva. 2012;24(2):173-8.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Engel et al.(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) and Meyer et al.(5353 Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262.)
|
|
No bone instability |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.) and Witcher et al.(5252 Witcher R, Stoerger L, Dzierba AL, Silverstein A, Rosengart A, Brodie D, et al. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation. J Crit Care. 2015;30(2):344-7.)
|
|
No orthopedic contraindications to mobilization |
-- |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Nava(3030 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849-54.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
Other |
No neuromuscular blocking agent |
-- |
Abrams et al.,(2121 Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18(1):R38.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Segers et al.(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) and Witcher et al.(5252 Witcher R, Stoerger L, Dzierba AL, Silverstein A, Rosengart A, Brodie D, et al. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation. J Crit Care. 2015;30(2):344-7.)
|
|
No open abdomen |
-- |
Clark et al.,(1111 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186-96.) Engel et al.,(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) Balas et al.(4747 Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.) and Hopkins et al.(5555 Hopkins RO, Miller RR 3rd, Rodriguez L, Spuhler V, Thomsen GE. Physical therapy on the wards after early physical activity and mobility in the intensive care unit. Phys Ther. 2012;92(12):1518-23.)
|
|
Not under palliative care |
-- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Médrinal et al.,(2323 Médrinal C, Lebret M, Bousta M, Nassaj A, Colas G. Effects of sitting at the bedside of the patient with mechanical ventilation. Kinesitherapie Revue. 2013;13(138):43-9.) Segers et al.,(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) Engel et al.,(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.) Titsworth et al.,(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.) Meyer et al.(5353 Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013;3(8):e003262.) and Hopkins et al.(5555 Hopkins RO, Miller RR 3rd, Rodriguez L, Spuhler V, Thomsen GE. Physical therapy on the wards after early physical activity and mobility in the intensive care unit. Phys Ther. 2012;92(12):1518-23.)
|
|
No deep vein thrombosis |
-- |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Needham et al.,(1414 Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271-81.) Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) and Drolet et al.(5050 Drolet A, DeJuilio P, Harkless S, Henricks S, Kamin E, Leddy EA, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013;93(2):197-207.)
|
|
Not under continuous hemodialysis |
-- |
Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Dammeyer et al.,(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.) Bourdin et al.(3838 Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400-7.) and Titsworth et al.(4343 Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012;116(6):1379-88.)
|
|
Body temperature |
< 38.5° |
Collings et al.,(1313 Collings N, Cusack R. A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.) Segers et al.,(3939 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082-8.) Wang et al.(4848 Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care. 2014;18(4): R161.) and Berney et al.(4949 Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012;92(12):1524-35.)
|
|
No active gastrointestinal bleeding |
-- |
Pohlman et al.,(22 Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089-94.) Schweickert et al.,(99 Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.) Brummel et al.(3333 Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, et al. A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Phys Ther. 2012;92(12):1580-92.) and Dammeyer et al.(3636 Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013;36(1):109-19.)
|
|
No active bleeding |
-- |
Abrams et al.,(2121 Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care. 2014;18(1):R38.) Timmerman,(3737 Timmerman RA. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007;26(5):175-9; quiz 180-1.) Lee et al.(2525 Lee H, Ko YJ, Suh GY, Yang JH, Park CM, Jeon K, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015;30(4):673-7.) and Engel et al.(4040 Engel HJ, Tatebe S, Alonzo PB, Mustille RL, Rivera MJ. Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther. 2013;93(7):975-85.)
|