Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians

Abstract

Objectives

To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU) as a multidisciplinary team.

Background

Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention.

Methods

A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale) strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team.

Discussion

These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of adverse outcomes (<2%). The tools and strategies described are useful not only to guide practical implementation of early mobilization, but also in the creation of a unit culture where ICU staff prioritize early mobilization and collaborate daily to provide the best possible care.

Conclusion

These practical tools allow ICU clinicians to safely and effectively implement early mobilization in critically ill patients. A genuinely multidisciplinary approach to safe mobilization in ICU is key to its success in the long term.

Keywords:

• physiotherapy (techniques)
• critical care
• intensive care
• multidisciplinary communication

Acknowledgments

The authors gratefully acknowledge the staff of the Physiotherapy Department and Intensive Care Unit of Canberra Hospital for their support in developing this protocol. They also gratefully acknowledge the patients, students, and staff who each kindly consented to publication of the photographs in this report. They thank the Canberra Hospital ICU Research Executive Committee and the ACT Health Chief Allied Health Office for their financial support of this publication.

Disclosure

The authors report no conflicts of interest in this work.