Table 2 Proposed criteria for discontinuation of mobilization and exercise therapy in critically ill patients
Category | Item/index | Acceptance criterion value or condition | Remarks |
|---|---|---|---|
Subjective symptoms | Pain, agony | Intolerable pain/agony | |
Fatigue | Intolerable fatigue | ||
Dyspnea | Sudden dyspnea | ||
Neurological system | Consciousness level (GCS or JCS) | Reduced consciousness level compared to the start | |
Facial expression | Distress, pallor of the face, and appearance of cyanosis | ||
Sedation (RASS), agitation | RASS ≤ − 3 or 2 < RASS Dangerous behaviors due to restlessness | ||
Voluntary movement of limbs | Limb weakness | ||
Respiratory system | Respiratory rate | RR < 5 breaths per minute or RR > 40 breaths per minute | Excludes temporary condition |
Arterial blood oxygen saturation | SpO2 < 88% or < 90% | SpO2 < 88% in cases with poor oxygenation Excludes temporary condition | |
Breathing patterns | Sudden increase in inspiratory or expiratory efforts (increased activity of neck accessory muscles, such as sternocleidomastoid, concavity of supraclavicular fossa, contraction of abdominal muscles, etc.) | Evaluation should include assessment of airway obstruction using techniques, such as auscultation | |
Mechanical ventilation | Non-synchronicity that does not improve even after changes in ventilation settings | ||
Bucking | Evaluate improvements by removal of airway secretions through aspiration | ||
Risk of accidental extubation or unplanned extubation of the endotracheal tube | |||
Cardiovascular system | Heart rate | HR < 40 bpm or HR > 130 bpm | If there is a significant decrease or increase in heart rate, even if it does not meet the criteria for discontinuation, discontinuation of mobilization or exercise therapy should be considered, and a physician should be consulted Excludes temporary condition |
Systolic blood pressure | sBP < 90 mmHg or sBP > 180 mmHg | If mobilization or exercise therapy has been initiated in a manner deviating from the criteria values on the left, the discontinuation criteria should be established as a team, including the physician. Similarly, if there is significant drop or rise in blood pressure without meeting the discontinuation criteria, mobilization or exercise therapy should be suspended, and a physician should be consulted Excludes temporary condition | |
Mean arterial pressure | MAP < 60 mmHg or MAP > 100 mmHg | ||
ECG findings | New arrhythmia requiring treatment Suspected myocardial ischemia | ||
Device | Device and catheter | Risk of catheter removal (or removal itself) Catheter insertion site bleeding Decreased flow rate | |
Other | Patient refusal or discontinuation appeal | ||
Characteristics of drainage | Suggested active bleeding | ||
Surgical wound condition | Wound dehiscence | ||
Sweating (hyperhidrosis), cold sweats |