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Clinical Algorithm Overview

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Mobility

Delphi Study Results

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Delphi Study Results
 

Phase 1: Summary of Comments

Group 3: Rehabilitation

  • Clinical algorithm for the Active Mobilization of Patients

      • Subject 1 : Importance of an individualized mobility plan
      • Subject 2 : Criteria to monitor a patient during early activity
      • Subject 3 : Grouping of patients
      • Subject 4 : Criteria used to determine the physiological stability
      • Subject 5 : Early activity
      • Subject 6 : Exercise plan for deconditioned patients
      • Subject 7 : Preliminary screening of all patients
      • Subject 8 : Criteria to determine stability of deconditioned patients



Clinical algorithm for the Active Mobilization of Patients

SUBJECT 1: Comments on the value and importance of the development of an individualized mobility plan in consultation with the interdisciplinary team on admission to the unit

AGREEMENT: 4/7
DISAGREEMENT: 0/7
NO RESPONSE: 3/7

POSTED COMMENTS:

  • No Comments

REFER TO REFORMULATION OF RECOMMENDATION 2


SUBJECT 2: Comments on the criteria used to monitor a patient during active mobilization
Comments on the criteria used to MONITOR a patient DURING early activity

AGREEMENT: 3/7
DISAGREEMENT: 1/7
NO RESPONSE: 3/7

POSTED COMMENTS:

  • Again, needs expansion to include other criteria quoted from my article. Spelling errors need fixing too!
 


SUBJECT 3: Comments on the grouping of patients before developing mobility plans

AGREEMENT: 2/7
DISAGREEMENT: 3/7
NO RESPONSE: 2/7

POSTED COMMENTS:


REFER TO REFORMULATION OF RECOMMENDATION 3



SUBJECT 4: Comments on the criteria to determine suitability of active mobilization for non intubated patients and patients that have been intubated for shorter than 14 days
Comments on the criteria used to determine the physiological stability for the initiation of early activity

AGREEMENT: 3/7
DISAGREEMENT: 2/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • I am not 100% sure about the platelet (cells/m3) consentration parameter. Normal platelet parameter count is between 150 000 to 400 000 cells/mm3. A value between 20 000 to 30 000 cells/mm3 can cause spontaneous bleeding and this patient will therefore not receive any physiotherapy modalities including any form of exercise.

  • Have to be careful as the criteria you are citing from my article are meant to be guidelines only ie not set criteria that must be met

  • I agree with all criteria except body temp < 38 degrees Celsius. In a trauma/surgical ICU setting pts seldom have a temp < 38 degrees Celsius but are stable enough to be mobilized without any adverse effects. Maybe the limit should be body temp < 38.5 degrees Celsius?
 

SUBJECT 5: Comments on the activities included for non intubated patients and patients that have been intubated for periodes less than 14 days
Comments on the specific ACTIVITIES included during early activity

AGREEMENT: 3/7
DISAGREEMENT: 3/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • Too simplistic again. For example, says to adjust FIO2 if patient desaturates - fair enough, but need to monitor much more than just SpO2 (eg HR, appearance)

  • I would suggest to include LOWER limb exercises (independent of the ability of being able to mobilize). I do not understand:agree with the level of 100m

  • I agree that activities listed for non-intubated pts and those ventilated < 5 days are acceptable. I want to suggest that lower limb exercises be introduced for those pts ventilated > 5 days. A rate of 2 - 5% loss of lean body mass/day has been reported by several researchers during critical illness and immobility. To mobilise succesfully, a patient needs strong lower limb muscles.
 

SUBJECT 6: Comments on the initiation of a directed exercise plan; intensity and frequency included for patients that have been intubated for periodes more than 14 days
Comments on intensity and frequency of a DIRECTED EXERCISE PLAN included for deconditioned patients

AGREEMENT: 2/7
DISAGREEMENT: 3/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • Again, too simplistic as noted before. The Rx duration and frequency are unrealistic for virtually all ICU patients. I don't think you can prescribe these things as they vary so much according to the actual patient

  • Why is this combination only included in the more than 14 days group? Details of the program (strength and endurance, intensity of exercise, modalities of exercise etc) should be kept in more general descriptions. Eeven referral to ACSM guidelines in terms of duration, frequency and intensity could be set as targets. There are no data to support any of the detailed statements.

REFER TO REFORMULATION OF RECOMMENDATION 3

 

SUBJECT 7: Comments on criteria used for the preliminary screening of patients considered for active mobilization
Comments on the criteria used for the PRELIMINARY SCREENING of patients considered for active mobilization

AGREEMENT: 3/7
DISAGREEMENT: 1/7
NO RESPONSE: 3/7

POSTED COMMENTS:

  • Needs expansion as respiratory, haemodynamic, cardiovascular criteria are not mentioned
 


SUBJECT 8: Comments on the criteria used to determine the stability of patients intubated for longer than 14 days to initiate exercise plan
Comments on the criteria used to determine the stability of deconditioned patients before initiating an exercise plan

AGREEMENT: 3/7
DISAGREEMENT: 2/7
NO RESPONSE: 2/7

POSTED COMMENTS:

  • A ventilated patient will most likely not be ventilated with a PEEP less than 5 cmH2O unless it might be an acute head injury patient.

  • I think these comments are relevant to patients irrespective of duration of intubation
 

 
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