Early mobilisation algorithm for the critical patient. Expert recommendations

Area of Science:

• Critical Care Medicine
• Physical Therapy
• Patient Outcomes

Background:

• Intensive care unit (ICU)-acquired weakness affects a significant portion of critically ill patients (40%-46%).
• Early Mobilization (EM) is a proven safe, feasible, and cost-effective intervention.
• EM demonstrates substantial short-term and long-term benefits for patient recovery.

Purpose of the Study:

• To develop a general Early Mobilization (EM) algorithm for critically ill patients.
• To outline specific EM recommendations for high-risk subpopulations.
• Targeted populations include neurocritical, traumatic, CRRT, VAD, and ECMO patients.

Main Methods:

• A comprehensive literature review was conducted.
• Databases searched include Medline, CINAHL, Cochrane, and PEDro.
• Focus on studies published within the last 10 years detailing EM protocols.

Main Results:

• Thirty articles met the inclusion criteria.
• Twenty-one articles provided general EM guidance; seven focused on neurocritical/traumatic patients.
• Specific protocols were identified for CRRT (1 article) and ECMO/VAD (1 article).
• Decision-making algorithms and safety criteria figures were developed.

Conclusions:

• The developed EM algorithms facilitate early patient mobilization (days 1-5 post-ICU admission).
• Key considerations before initiating mobilization are outlined.
• Essential safety criteria for discontinuing mobilization are provided.