In the intensive care unit (ICU), patient mobilization may be restricted or limited based on various medical conditions and circumstances. The benefits of early mobilization can result in improved outcomes, reduced length of stay, reduced risk for pressure injury and a reduction in delirium and ICU-associated weakness. The decision to mobilize a patient in the ICU depends on the individual’s clinical status, medical needs, and the overall assessment by the healthcare team. Here are some situations where patient mobilization, out of the bed, might be limited or not recommended:
- Hemodynamic instability: Patients with unstable blood pressure, heart rate, or other hemodynamic parameters may not be suitable for mobilization as it can lead to further complications.
- Respiratory instability: Patients who are dependent on mechanical ventilation or have significant respiratory distress may require careful consideration before mobilization.
- Severe neurological impairment: Patients with severe neurological issues, such as those with uncontrolled seizures or altered mental status, may not be safe candidates for mobilization.
- Spinal precautions: Patients with suspected or confirmed spinal cord injuries may require spinal precautions, limiting their ability to be mobilized until the spine is stabilized.
- Fractures or orthopedic issues: Patients with fractures or other orthopedic conditions may need to be assessed on a case-by-case basis to determine the appropriate level of mobilization.
- Active bleeding or high-risk clotting disorders: Patients with active bleeding or conditions that pose a high risk of bleeding may need to be carefully monitored before mobilization.
- Recent surgery or procedures: Patients who have undergone recent surgical procedures or interventions may need time to recover before being mobilized.
- Multiorgan failure: Patients with multiple organ failure or those with severe systemic illness may require cautious mobilization or may not be suitable for it.
- Obesity or immobility: Extremely obese patients or those with severe limitations in mobility may face challenges in being mobilized, and the healthcare team may need to use specialized equipment or techniques.
It’s important to note that each patient is unique, and decisions regarding mobilization in the ICU should be made on an individual basis by the healthcare team. Team members should consider in-bed mobilization options for patients that are unable to move from the bed such as in-bed physical therapy and verticalization beds that allow for patients to move into an upright position while staying in bed (if they meet the inclusion criteria of the bed). Continuous monitoring, assessment, and communication among healthcare professionals are crucial to ensuring patient safety during mobilization efforts in the ICU.