Describing Usual Care Mobilization with Mechanically Ventilated Patients According to the Rehabilitation Treatment Specification System

Summary

To characterize common intensive care unit (ICU)-based mobilization activities delivered by physiotherapists and the ICU multidisciplinary team as part of usual care. Activities are described according to the Rehabilitation Treatment Specification System.

Abstract

Mobilization in the intensive care unit (ICU) for mechanically ventilated patients is a complex intervention. In critical care rehabilitation, patient recovery should not be limited by hospital location (e.g., ICU or hospital ward). Critically ill patients are among the most medically complex in the hospital; therefore, clinicians providing mobilization require a thorough understanding of critical illness, patient recovery trajectories, and available rehabilitation techniques. Mobilization requires coordination among multidisciplinary team members, careful preparation, and strong clinical assessment and decision-making skills. Usual care is the most common comparator group in randomized controlled trials of ICU mobilization; however, it is often under-specified. As a result, there is limited understanding of the specific activities, clinical decision-making processes, and therapist actions that constitute usual care. In this manuscript, the Rehabilitation Treatment Specification System (RTSS) is applied to describe protocols for common usual care mobilization activities for mechanically ventilated ICU patients. Preparation, clinician actions (e.g., instructions, feedback, and equipment provision), progression considerations, and clinical decision-making are described for each activity to enhance transparency and support reproducibility of usual care mobilization practices.

Introduction

Individuals who survive a critical illness are likely to experience debilitating physical and functional deficits, largely resulting from prolonged immobility while receiving life-saving treatment(s) in the intensive care unit (ICU)¹. Rehabilitation encompasses a broad range of interventions aimed at restoring or improving function², whereas mobilization is a subset of rehabilitation that includes passive or active physical activities aimed at restoring or improving movement³. Both rehabilitation and/or mobilization initiated in the ICU are recommended by the Society of Critical Care Medicine (SCC....

Protocol

This protocol follows institutional guidelines for research involving human participants. Ethics approval was not required for this descriptive methods paper. Ethical approval for the Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) randomized clinical trial (RCT) was obtained at each of the 17 participating sites. Written informed consent for publication of photographs was obtained from the individuals shown in Figure 1 and Figure 2.

The CYCLE RCT²⁰ compared the effects of early in-bed cycling along with usual care rehabilitation versus usu....

Results

Recent guidelines from the Society of Critical Care Medicine (SCCM) recommend delivering rehabilitation or mobilization for critically ill adults as part of usual care, as it is safe, feasible, and may improve patient outcomes⁴. This manuscript provides detailed guidance on how to deliver common mobilization activities for mechanically ventilated patients in the ICU that can be implemented by trained ICU clinicians.

Following the implementation of this protocol, trained.......

Discussion

The protocol describes activities commonly delivered during usual care mobilization for mechanically ventilated patients in the ICU. By detailing these activities, it becomes evident that ICU mobilization encompasses far more than ambulation, contrary to common perceptions. This description emphasizes the complex and nuanced decision-making undertaken by ICU clinicians when determining which activities are appropriate for a given patient and when, informed by continually changing physiological status and functional abili.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Central venous catheter	Equipment use and availability may vary by patient and/or by centre.
Central venous catheter pressure bag
Continuous passive motion (CPM) machine
Continuous renal replacement therapy (CRRT) machine
Cycle ergometer (arm/leg)
Endotracheal tube
Foley catheter
Free weights
Gait aid
ICU bed (adjustable bed with mechanics and rails)
Intravenous (IV) infusion pump
Mechanical lift/hoist (ceiling or mobile)
Mechanical ventilator
Mobile pole for patient attachments
Patient chair/bedside chair
Patient virtal signs monitor
Peripheral IV catheter
Resistance bands
Standing device
Surgical drain collection bag
Urine collection bag
Walking frame
Wheelchair