1. Clinical algorithm for the passive mobilization of an unresponsive patient
Next step in the algorithm

2. On admission to unit
Develop an individually designed mobility plan with outcomes for each patient in consultation with rest of the team.
Monitor daily and provide feedback
(Nava 2000; Nava 2002; Thomas 2002; Vollman 2004)
Recommendation 1
Next step in the algorithm

3. Does patient present with any
Neurological contra indications?
Orthopedic contra indications?
Recent SSG? NO
YES

4. Discuss with interdisciplinary team
Decide on a specific mobility plan for the patient including outcome measures and monitor accordingly
Back to algorithm

5. Patient has sufficient cardiovascular reserve?
MAP > 60mmHg
No new cardiac arythmias visible on ECG;
HR < 75% APM
Low dose inotrope support:
Dopamine <10mcg/kg/min;
Nor/adrenaline<01mcg/kg/min
EXPERT OPINION
Thomas et al 2006 NO
YES

6. Initiate basic elements of a mobility plan
Two hourly change of position supine – quarter turn (Topp 2002; Thomas 2006; Krishnagopalan et al 2002)
Nurse in degrees head up position (supine) (I RCT Dodek et al 2004)
Passive movement of upper and lower extremities once daily through full range (Morris 2007; Winkelman 2007; Nava 2002)
EXPERT OPINION
Topp et al 2002; Thomas et al 2006; Krishnagopalan et al 2002; Morris 2007; Winkelman 2007; Nava 2002
Previous step in the algorithm