SAFEMOB: Difference between revisions
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== When to Consider Not Mobilizing<ref name="Morris 2008">Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, | == When to Consider Not Mobilizing<ref name="Morris 2008">Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine,fckLR2008; 36:2238-43.</ref><ref name="Stiller 2007">Stiller, K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007; 23, 35-53.</ref><ref name="Schweickert 2009">Schweickert WD, Pohlman MC, Pohlman NS Nigos C, Pawlik AJ, Esbrook CL et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: an RCT. Lancet. 2009; 373:1874-82.</ref><ref name="ACSM 2010">ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams &amp; Wilkins. Philadelphia 2010 pp.209-10.</ref><ref name="Timmerman 2007">Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9.</ref><ref name="Singh 2009">Singh C, Fletcher R, Cunningham K, and Szlivka M. Mobilization with a Deep Vein Thrombosis. Clinical Practice Guideline (DRAFT in process). Fraser Health Authority. 2009.</ref> == | ||
Lancet. 2009; 373:1874-82.</ref><ref name="ACSM 2010">ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams & Wilkins. Philadelphia 2010 pp.209-10.</ref><ref name="Timmerman 2007">Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9.</ref><ref name="Singh 2009">Singh C, Fletcher R, Cunningham K, and Szlivka M. Mobilization with a Deep Vein Thrombosis. Clinical Practice Guideline (DRAFT in process). Fraser Health Authority. 2009.</ref> == | |||
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*'''''Mean arterial pressure''''': <65<ref name="Morris 2008">Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 2008; 36:2238-43.</ref> or >110 | *'''''Mean arterial pressure''''': <65<ref name="Morris 2008">Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 2008; 36:2238-43.</ref><ref name="Schweickert 2009" /> or >110<ref name="Schweickert 2009" /> | ||
*'''''BP''''': A drop in systolic pressure (>20 mm Hg) or below pre-exercise level OR a disproportionate rise i.e. | *'''''BP''''': A drop in systolic pressure (>20 mm Hg) or below pre-exercise level OR a disproportionate rise i.e. >200 mm Hg for systolic or >110 mm Hg for diastolic<ref name="ACSM 2010" /> | ||
*'''''HR''''': <40 | *'''''HR''''': <40<ref name="Schweickert 2009" /> or >130<ref name="Schweickert 2009" /><ref name="Timmerman 2007" />; requiring temporary pacer. | ||
*'''''Hemodynamic''''': Administration of a new pressor e.g. inotropes agent<ref name="Morris 2008" />; two or more pressor or frequent increase | *'''''Hemodynamic''''': Administration of a new pressor e.g. inotropes agent<ref name="Morris 2008" />; two or more pressor or frequent increase<ref name="Timmerman 2007" />; uncontrolled systemic hypertension; active bleeding<ref name="Schweickert 2009" /><ref name="Timmerman 2007" /> | ||
*'''''Acute or unstable cardiac status''''': New MI <ref name="Morris 2008" />; dysrhythmia requiring new medications<ref name="Morris 2008" />; active cardiac ischemia | *'''''Acute or unstable cardiac status''''': New MI<ref name="Morris 2008" />; dysrhythmia requiring new medications<ref name="Morris 2008" />; active cardiac ischemia<ref name="Schweickert 2009" />; unstable rhythm<ref name="Timmerman 2007" />; intra aortic balloon<ref name="Timmerman 2007" /> | ||
*'''''Pulmonary embolus''''': Discussion with physician required to determine suitability | *'''''Pulmonary embolus''''': Discussion with physician required to determine suitability | ||
*'''''Deep venous thrombosis''''': May mobilize as tolerated immediately after low molecular weight heparin (e.g. enoxaparin (lovenox®), dalteparin (fragmin®), tinzaparin (innohep®), nadroparin (fraxiparine®)) is given | *'''''Deep venous thrombosis''''': May mobilize as tolerated immediately after low molecular weight heparin (e.g. enoxaparin (lovenox®), dalteparin (fragmin®), tinzaparin (innohep®), nadroparin (fraxiparine®)) is given; If patient is on any other form of anticoagulation (e.g. IV heparin) please check mobility orders with the physician; Monitor patient for changes in pain, swelling, colour and sudden shortness of breath<ref name="Singh 2009" /> | ||
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*'''''SpO<sub>2</sub>''': ''<88%<ref name="Morris 2008" /> | *'''''SpO<sub>2</sub>''': ''<88%<ref name="Morris 2008" /><ref name="Schweickert 2009" /> or undetermined cyanosis | ||
*'''''RR''''': <5 or >40 | *'''''RR''''': <5 or >40<ref name="Schweickert 2009" /> | ||
*'''''F<sub>i</sub>O<sub>2</sub>'': '''>60% | *'''''F<sub>i</sub>O<sub>2</sub>'': '''>60%<ref name="Timmerman 2007" /> | ||
*'''''Ventilator issues''''': Decreased ventilatory support that could precipitate fatigue or increased ventilatory support; ventilator asynchrony | *'''''Ventilator issues''''': Decreased ventilatory support that could precipitate fatigue or increased ventilatory support; ventilator asynchrony<ref name="Schweickert 2009" />; unsecure airway<ref name="Schweickert 2009" />; pressure control ventilation<ref name="Timmerman 2007" />; uncontrolled airway irritability | ||
*'''''Uncontrolled asthma''''' | *'''''Uncontrolled asthma''''' | ||
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*'''''Patient status''''': Severe agitation, distress, or combative | *'''''Patient status''''': Severe agitation, distress, or combative<ref name="Stiller 2007" /><ref name="Schweickert 2009" />; not able to understand instructions thus risking patient or therapist safety | ||
*'''''ICP''''': | *'''''ICP''''': Increased<ref name="Schweickert 2009" /> i.e. >20 mm Hg, however, ICP needs to be considered in conjunction with cerebral compliance | ||
*Uncleared, unstable/non fixated spinal cord injury | *Uncleared, unstable/non fixated spinal cord injury<ref name="Timmerman 2007" /> or head injury | ||
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*Intermittent hemodialysis | *Intermittent hemodialysis<ref name="Schweickert 2009" /> | ||
*Unstable fracture | *Unstable fracture | ||
*Excessive muscle soreness or fatigue that is residual from last exercise or activity session | *Excessive muscle soreness or fatigue that is residual from last exercise or activity session |
Revision as of 07:01, 8 January 2014
Developed by the SAFEMOB Task Force:
Dr. Elizabeth Dean, Dr. Darlene Reid, Frank Chung, Simone Gruenig, Rosalyn Jones, Jocelyn Ross, Maylinda Urbina, Alison Hoens.
SAFE PRESCRIPTION OF MOBILIZING PATIENTS IN ACUTE CARE SETTINGS[edit | edit source]
What to Assess, What to Monitor, When not to Mobilize, and How to Mobilize and Progress
Purpose, Scope, & Disclaimer[edit | edit source]
The purpose of this document is to provide physical therapists with guidance on safe mobilization of the patient in acute care settings. This decision-making guide is evidence informed and where there is insufficient evidence, expert informed. It is not intended to replace the clinician’s clinical reasoning skills and interprofessional collaboration. Mobilization, for the purposes of this document, has been defined as “To work towards the functional task of locomotion”.
What to Assess[edit | edit source]
The Chart | The Patient, Family, and Team Member |
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When to Consider Not Mobilizing[1][2][3][4][5][6][edit | edit source]
Cardiovascular Status | Respiratory Status |
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Neurological Status | Other |
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- Please note: The cited values are not absolute criteria for withholding mobilization but are within the range of concern that could benefit from team discussion.
What to Consider During Mobilization[edit | edit source]
Subjective | Objective |
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How to Mobilize and Progress[edit | edit source]
Step 1: Prepare | Step 2: Safety First |
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Step 3: When to Quite While You are Still Ahead | Step 4: Monitor and Progress |
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References[edit | edit source]
1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 2008; 36:2238-43. 2. Stiller, K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007; 23, 35-53. 3. Schweickert WD, Pohlman MC, Pohlman NS Nigos C, Pawlik AJ, Esbrook CL et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: an RCT. Lancet. 2009; 373:1874-82. 4. ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams & Wilkins. Philadelphia 2010 pp.209-10. 5. Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9. 6. Singh C, Fletcher R, Cunningham K, and Szlivka M. Mobilization with a Deep Vein Thrombosis. Clinical Practice Guideline (DRAFT in process). Fraser Health Authority. 2009. 7. Reid WD, Chung F. Clinical management notes and case histories in cardiopulmonary physical therapy. New Jersey: Slack; 2004. 8. Chung F, Fletcher R, Lavoie K, Parrent L, Perret D, Roy L, Urbina,M. Members of the physiotherapy professional practice council critical care practice stream for the Fraser Health Authority. Canada. Forthcoming. 2009. 9. 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; 35:139-45. 10. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med. 2003;138:494-501. 11. Dodek P, Keenan S, Cook D, MD, Heyland D, Jacka M, Hand L et al. Evidence-based clinical practice guideline for the prevention of ventilator associated pneumonia. Ann Intern Med. 2004; 141:305-13. 12. Needham D. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008; 300:1685-90. 13. 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; 18:212-21. 14. Sessler CN, Gosnell M, Grap MJ, Brophy GT, O'Neal PV, Keane KA et al. The Richmond Agitation-Sedation Scale: validity and reliability. Am J Respir Crit Care Med 2002; 166:1338-44.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine,fckLR2008; 36:2238-43. Cite error: Invalid
<ref>
tag; name "Morris 2008" defined multiple times with different content - ↑ 2.0 2.1 Stiller, K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007; 23, 35-53.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Schweickert WD, Pohlman MC, Pohlman NS Nigos C, Pawlik AJ, Esbrook CL et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: an RCT. Lancet. 2009; 373:1874-82.
- ↑ 4.0 4.1 ACSM Guidelines for Exercise Testing and Prescription. 8th edition. Lippincott Williams & Wilkins. Philadelphia 2010 pp.209-10.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Timmerman, RA. A mobility protocol for critically ill adults. [DIMENS CRIT CARE NURS. 2007; 26(5):175-9.
- ↑ 6.0 6.1 Singh C, Fletcher R, Cunningham K, and Szlivka M. Mobilization with a Deep Vein Thrombosis. Clinical Practice Guideline (DRAFT in process). Fraser Health Authority. 2009.