Early mobilisation algorithm for the critical patient. Expert recommendations

Enferm Intensiva (Engl Ed). Jul-Sep 2021;32(3):153-163. doi: 10.1016/j.enfie.2020.11.001. Epub 2021 Aug 6.

Abstract

Introduction: Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term.

Objective: To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO).

Methodology: Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions.

Results: 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each.

Conclusions: The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.

Keywords: Algorithm; Algoritmo; Debilidad adquirida en la UCI; Early mobilisation; Intensive care unit; Movilización temprana; Unidad de cuidados intensivos; Weakness acquired in the ICU.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Early Ambulation*
  • Extracorporeal Membrane Oxygenation*
  • Humans
  • Intensive Care Units
  • Physical Therapy Modalities