Table 4 Multihospital common early mobilization protocol
Level 1 respiratory (RASS − 5 approximately to – 3) | Level 2 HOB (RASS ≥ − 3) | Level 3 sitting (RASS ≥ − 1) | Level 4 standing (RASS ≥ 0) | Level 5 gait (RASS ≥ 0) |
|---|---|---|---|---|
Physical therapy â–¡ Passive ROM exercise â–¡ Respiratory physical therapy | Physical therapy â–¡ Positioning â–¡ Passive ROM exercise â–¡ Active ROM exercise â–¡ Respiratory physical therapy â–¡ Continuous lateral rotation therapy | Physical therapy â–¡ Positioning â–¡ Passive ROM exercise â–¡ Active ROM exercise â–¡ Sitting at side of bed â–¡ Rising from the supine position | Physical therapy â–¡ Positioning â–¡ Passive ROM exercise â–¡ Active ROM exercise â–¡ Standing at side of bed â–¡ Stand and pivot to a chair | Physical therapy â–¡ Positioning â–¡ Passive ROM exercise â–¡ Active ROM exercise â–¡ Walk with assistance â–¡ Walk independently |
Positioning □ Posture change □ HOB ≤ 45 degrees | Positioning □ Posture change □ HOB ≥ 60 | Positioning □ Posture change □ HOB ≥ 60 | Positioning □ Posture change □ HOB ≥ 60 | Positioning □ Posture change □ HOB ≥ 60 |
Step up criterion □ Oxygenation/hemodynamic stability □ Can withstand posture change □ Can withstand HOB ≤ 45 degrees | Step up criterion □ Can withstand supplementary motion of physical therapy □ Can withstand HOB ≤ 60 degrees □ Anti-gravity movement possible | Step up criterion □ Can endure the active movement of physical therapy □ Can withstand HOB ≤ 60 degrees □ Can withstand sitting at side of bed | Step up criterion □ All exercise can be carried out □ Can withstand partial weight standing | Step up criterion □ Increase walking distance gradually |
Step up criterion to level 3 or higher are defined as: RASS − 1 to + 2, BPS ≤ 3 or NRS ≤ 5, SpO2 ≥ 91%, FIO2 > 0.6, respiratory rate < 30 times/min, systolic blood pressure 90 to 180 mmHg, mean blood pressure 65 to 110 mmHg, heart rate 60 to 120 times/min, there were no new arrhythmias, no additional administration of vasopressors, no bleeding, no wound with the possibility of separation, and no unstable fracture. | ||||