1. Early Mobilization In the Intensive Care Setting Lauren Wesson-Stout
University of South Florida, College of Nursing

2. Objectives Define early mobilization within the intensive care setting
Identify benefits of early mobilization
Discuss current evidence-based research supporting the use of early mobilization in the ICU

3. What is early mobilization?
Getting patients moving!
Includes sitting, moving to a chair, ambulating, and AROM and PROM exercises based on patient status
Evaluate patients individually to determine if they are stable for mobilization

4. Risks of Immobility Increased length of hospital stay
Increased mortality
Increased muscle atrophy
Increased risk of aspiration
Increased rate of return to ICU

5. Benefits of Early Mobilization
Improved functional independence
Reduced ICU delirium
Reduced duration of mechanical ventilation
Reduced ICU (and hospital) length of stay
Improved walk distance
Improved muscle strength

6. Goals of Mobility for TGH
Reduce bounceback
Patients should be out of bed before transfer to floor
Patient should maintain pre-hospital mobility
Prevent pressure ulcers

7. Patient Data
Inconsistent over the months – some there are multiple pts out of bed, some very few. What are the reasons for noncompliance?

8. Perceived Barriers Lack of understanding of mobility benefits
Patient status
Resources

9. Early Progressive Mobility Protocol – Step One
Evaluation of patient – if they meet these requirements, move to step 2.

10. Early Progressive Mobility Protocol – Step Two

11. Resource Solutions Interdisciplinary Involvement Physician Groups
Respiratory Therapy
Physical Therapy
Lift Team
Patient Care Technicians
Physician – activity level ordered
RT – vented pts
PT – mobility people! Machinery/equipment
Lift – help with sitting up
PCT – help with ambulating/assistance

12. Mobility Technician (MT)
Turn patients every two hours
Responsible for PROM exercise
Ambulate stable patients
Tech is with lift team during rounds – available to help pts

13. Delegation Level 1 Level 2 Level 3 Level 4 Passive ROM – MT
Turn every 2 hours – Lift Team/MT
Level 2
Active resistance exercise – PT
Sitting position for 20 minutes – Lift Team/MT
Level 3
Active transfer to chair – PT/MT/RT
Level 4
Stand at bedside – PT/MT/RT
Ambulating in hallway – PT/MT/RT
Nurse is involved in all levels – these represent the assistance available to the RN

14. Evaluation
Audit – can be performed by mobility tech/RN on staff. Ask each room if OOB for the day (or if pt didn’t meet mobilization requirements)

15. References and Research
Bourdin, G., Barbier, J., Burlem, J., Durante, G., Passant, S., Vincent, B., Badet, M., & Guerin, C. (2010). The feasibility of early physical activity in intensive care unit patients: a prospective observational one- center study. Respiratory Care, 55(4), Retrieved from
Clark, D., Lowman, J., Griffin, R., Matthews, H., & Reiff, D. (2013). Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. American Physical Therapy Association, 93(2), doi: /​ptj
Engel, H., Needham, D., Morris, P., & Gropper, M. (2013). Icu early mobilization: from recommendation to implementation at three medical centers. Critical Care Medicine, 41. doi: /CCM.0b013e3182a240d5
Hopkins, R. (2010). Early activity in the icu: beyond safety and feasibility. Respiratory Care, 55(4), Retrieved from

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Leditschke, I., Green, M., Irvine, J., Bissett, B., & Mitchell, I. (2012). What are the barriers to mobilizing intensive care patients?. Cardiopulmonary Physical Therapy Journal, 23(1), Retrieved from
Mah, J., Staff, I., Fichandler, D., & Butler, K. (2012). Resource-efficient mobilization programs in the intensive care unit: who stands to win?. The American Journal of Surgery, 206(4), doi: /j.amjsurg
Meyer, M., Stanislaus, A., Lee, J., Waak, K., Ryan, C., Saxena, R., Ball, S., & Eikermann, M. (2013). Surgical intensive care unit optimal mobilisation score (soms) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical icu patients. BMJ Open, 3(8). doi: /bmjopen
Morris, P., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., Ross, A., & Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), doi: /CCM.0b013e318180b90e
Pires-Neto, R., Kawaguchi, Y., Hirota, A., Fu, C., Tanaka, C., Caruso, P., Park, M., & Carvalho, C. (2013). Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects - a case series. PLoS One, 8(9). doi: /journal.pone
Schweickert, W., & Kress, J. (2011). Implementing early mobilization interventions in mechanically ventilated patients in the icu. Chest, 140(6), doi: /chest

17. Schweickert, W. , Pohlman, M. , Pholman, A. , Nigos, C. , Pawlik, A
Schweickert, W., Pohlman, M., Pholman, A., Nigos, C., Pawlik, A., Esbrook, C., Spears, L., & Kress, J. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), doi: /S (09)
Zomorodi, M., Topley, D., & McAnaw, M. (2012). Developing a mobility protocol for early mobilization of patients in a surgical/trauma icu. Critical Care Research and Practice. Retrieved from