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DOI 10.1007/s00134-017-4908-8
Paent
1) Evaluate pre-ICU & current • Evaluate premorbid funcon and ICU-related impairments; consider frailty
funconal status evaluaon and an ICU-specific funconal scale (e.g. PFIT-s, FSS-ICU, IMS, CPAx)
2) Assess current physiological • Include assessment of pain, sedaon, and delirium status using recommended
status instruments (e.g. CPOT, RASS, CAM-ICU)
• Evaluate if benefits outweigh potenal risks, and what intervenons are feasible
3) Evaluate feasibility & safety with available resources
4) Select mobility target & • Set areas to target (e.g., strength, endurance, aerobic capacity, ADLs)
intervenon(s) • Select appropriate intervenons & combine with other daily care acvies
• Plan & coordinate with team and paent; consider integraon of family
5) Communicate & reinforce goals • Set & reinforce dynamic individualized goals
• Prepare required equipment, and secure lines, tubes and medical devices
6) Perform intervenons • Perform stepwise intervenons, re-assessing safety status and criteria
• Assess paent progress at least weekly & at ICU discharge, with handover to
7) Evaluate progress next team
Fig. 1 Approach to implementing physical rehabilitation and mobilisation in the ICU. Relevant considerations at both the team- and patient-level
are outlined to enable implementation of physical rehabilitation and mobilisation in the intensive care unit
Engage and evaluate with inter‑professional team within the inter-professional team (e.g. mobilisation
Designated champions to support and advocate for reha- techniques, and anticipating and reacting to potential
bilitation, as part of daily clinical care, are essential [7, 8]. risks/safety issues) can improve clinician confidence and
Engagement activities can include patients returning to capability.
the ICU to share their story of post-ICU recovery-related
challenges, comparing local data on patient mobility Establish communication and coordination plan for safety
with peer hospitals and sharing local ‘success stories’ of Rehabilitation and mobilisation, especially as part of the
rehabilitation activities [8]. As part of a structured qual- ABCDE bundle, requires team communication and coor-
ity improvement approach, regular audit and feedback dination [4]. Mobility rounds or checklists can facilitate
regarding progress is integral to the evolution of ICU inter-professional discussions [6, 7, 14] and assist with
mobility programs [8]. prioritisation and coordination of the timing of interven-
tions with other ICU procedures. Assessment of potential
Educate inter‑professional team risks to patients and staff, and pre-planning regarding the
Sharing the substantial available evidence regarding the required staff and equipment (e.g., walking aids, cardiac
safety and benefit of rehabilitation and mobilisation in monitor) are essential for safe rehabilitation and mobilisa-
the ICU [11, 12] is an important aspect of education for tion. One team member should be designated as a leader,
all staff, with emphasis on using existing practical safety- and specific team members’ responsibilities should be
related recommendations to aid in clinical decision-mak- clear. In particular, we recommend designating one person
ing for patient mobility [13]. Moreover, skills training to be responsible for the airway and ensuring emergency
airway equipment is available. Developing a back-up plan, Abbreviations
ADLs: Activities of daily living; CAM-ICU: Confusion assessment method for
prior to mobilisation, is needed in case the patient dete- the ICU; CPAx: Chelsea critical care physical assessment tool; CPOT: Critical
riorates or fatigues, which may include specific strategies, care pain observation tool; FSS-ICU: Functional Status Score for the ICU; ICU:
such as immediate access to a bed or wheelchair [14]. Intensive care unit; IMS: ICU Mobility Scale; PFIT-s: Physical function in ICU test-
scored; RASS: Richmond Agitation and Sedation Scale.