Guidelines for Early Mobilisation of Intubated Patients in Intensive Care Unit: Clinical Pathology Evidence-Base Perspective

Abstract

Abstract Intensive care unit (ICU) patients can be immobilised over long periods due to their conditions, and the subsequent management inclusive of mechanical ventilation, which is also associated with complications. Hence, early mobilization of intubated patients (EMIP) may be beneficial but there are various barriers including the lack of consensus guidelines. Based on a brief scoping literature review, this article notes of perhaps one consensus guidelines developed from a systematic review in 2014 followed by a meeting of experts from ICU but there are other guidelines, recommendations, and strategies. However, there still exists the challenge of consensus guidelines for early mobilization. Barriers and/or facilitators, evaluation of optimal intervention dosage, good communication, and use of necessary assistive equipment have also been identified. Some resource limited countries lack physiotherapists and equipment, and these services are therefore provided mostly by nurses and junior doctors, which calls for tailored guidelines. Prominent note in the guidelines is oximetry but not blood gas measurement and another note are the limitations caused by vasoactive agents. Perhaps, the cost and invasive nature of the blood gas analyses are concerns and this is significant for resource limited countries. However, this test and alternatives need considerations in the guidelines. There is agreement on safe early mobilisation of intubated patients (EMIP), but this requires developing to tailor for resource limited countries. The vasoactive agents affect blood gases, hence evidence-base blood gases and acid–base analyses are necessary to integrate in monitoring intubated patients in ICU. Given the four criteria (cardiovascular, neurological, respiratory, and ‘others’) and challenges in the existing guidelines, some laboratory tests are recommended as additional items to the ‘others’ criterion to improve on potential points of imprecision and risk of bias.

Keywords

• Blood gas analyses
• Mechanical ventilation
• Intubation
• Mobilisation
• ICU