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The safety of mobilisation and its effect on
haemodynamic and respiratory status of intensive
care patients
Kathy Stiller, Anna C. Phillips, and Paul Lambert
This study investigated the safety of mobilising acutely ill in-patients, in particular
the effect of mobilisation on their haemodynamic and respiratory parameters.
Thirty one patients in an intensive care unit (ICU) deemed suitable for
mobilisation, based on a comprehensive screening process, received 69 mobilisation
treatments in total. These treatments most often included sitting on the edge of the
bed and standing. Outcome measures including heart rate, systolic and diastolic
blood pressure, and percutaneous saturation of oxygen, were measured prior to,
during and after mobilisation. Additionally, any deterioration in clinical status, and
intervention required for it, was noted. On the majority of occasions (91.3%), pre-
treatment data from patients indicated marginal cardiac and=or respiratory reserve.
During mobilisation, significant increases were seen in heart rate and blood
pressure, while percutaneous oxygen saturation decreased (not significantly). These
changes were generally of small magnitude and did not require any specific
intervention. On three of the 69 occasions of mobilisation (4.3%), clinical status
deteriorated, requiring intervention. For all three patients involved, this was a fall in
oxygen saturation, requiring a temporary increase in the inspired fraction of
oxygen to stabilise respiratory status. Although mobilisation resulted in significant
increases in heart rate and blood pressure and a non-significant fall in percutaneous
oxygen saturation, the ICU patients in this study deemed suitable for mobilisation
were able to be safely mobilised.
INTRODUCTION
The physiotherapy management of acutely ill
patients who are in an intensive care unit (ICU)
often incorporates some form of mobilisation.
The aims of mobilisation for these patients
include increasing lung volumes, improving
ventilation=perfusion matching, providing a
gravitational stimulus to restore normal fluid
distribution in the body, reducing the effects of
immobility, and maintaining or improving
function and fitness (Bishop, 1996; Dean, 1994;
Dean and Ross, 1992a, 1992b ; Stiller and Phillips,
2003). Although mobilisation is deemed an
Kathy Stiller, B App Sc, PhD, Senior Physiotherapist, Physiotherapy Department, Royal Adelaide
Hospital, North Terrace, Adelaide, SA 5000, Australia. E-mail: Kstiller@mail.rah.sa.gov.au
Anna C. Phillips, B App Sc, Senior Physiotherapist, Physiotherapy Department, Royal Adelaide
Hospital, North Terrace, Adelaide, SA 5000, Australia.
Paul Lambert, B App Sc, Senior Physiotherapist, Physiotherapy Department, Royal Adelaide
Hospital, North Terrace, Adelaide, SA 5000, Australia.
Accepted for publication 22 March 2004.
Physiotherapy Theory and Practice, 20: 175185, 2004
Copyright # Taylor & Francis Inc.
ISSN: 0959-3985 print=1521-0510 online
DOI: 10.1080/09593980490487474
essential part of the physiotherapy manage-
ment of acutely ill in-patients, a literature
search (of Medline and CINAHL databases)
revealed that there is no published clinical
research assessing the overall safety of mobilis-
ing these patients, nor the effect of mobilisation
on haemodynamic and respiratory status. This
is an important omission as there is the poten-
tial for adverse side effects, especially given the
borderline cardiorespiratory function of acutely
ill patients. Thus, the aim of this pilot study was
to document the safety of mobilisation for
acutely ill patients in ICU, in particular the
haemodynamic and respiratory responses and
the occurrence of any adverse side effects
during mobilisation.
METHOD
A prospective study was done over three
separate two week periods at the Royal
Adelaide Hospital (RAH) ICU and included
all patients where mobilisation formed part of
the patient’s physiotherapy man agement.
These distinct time periods were selected to
ensure that a wider selection of patients was
included in the study sample than would have
been the case if one continuous time period
was used. For the purposes of this study,
mobilisation was defined as moving from lying
to sitting on the edge of the bed, sitting to
standing, a standing transfer from the edge of
the bed to a chair, or walking. Patients under-
going passive forms of mobilisation, such as
positioning upright in bed and mechanical
transfers from bed to chair were not studied.
The mobilisation task selected was based on the
patient’s general clinical status and ability.
Prior to mobilising any patient, a comprehen-
sive range of factors including medical back-
ground, cardiovascular reserve, respiratory
reserve and other relevant factors, were taken
into consideration to assess whether mobilisa-
tion was safe to proceed. This screening pro-
cess is based on that described by Stiller and
Phillips (2003) and is summarised in flow chart
format in Figure 1.
Background pre-treatment data were
recorded, including descriptive information
(e.g., primary diagnosis, major past medical
history, days post-admission to ICU, intuba-
tion=ventilation status), haematological data
(e.g., haemoglobin, platelet count, white cell
count), body temperature and weight. In add-
ition, for those patients with an arterial line,
the ratio of partial pressure of oxygen in
arterial blood to the inspired fraction of oxygen
(PaO
2
=FIO
2
ratio) was calculated from the
most recent arterial blood gas (ABG) as an
indication of oxygenation and respiratory
reserve (see Table 1).
For the purposes of this study, outcome
measures were selected that were easily acces-
sible in a clinical setting. Heart rate (HR) was
recorded from the electrocardiograph (ECG)
monitor, after ensuring that a satisfactory tra-
cing was present. In addition to recording the
absolute value of HR, HR was also expressed as
a percentage of the age predicted maximum
HR (where the age predicted maximum HR
equals 220 minus age, in years) to give an
indication of cardiac reserve (Franklin, Whaley,
and Howley, 2000; McArdle, Katch, and Katch,
1996; Stiller and Phillips, 2003). The cardiac
rhythm was observed on the ECG tracing and
any arrhythmias documented. Systolic and dia-
stolic blood pressure (BP) were recorded from
an invasive arterial line or, for those patients
without an arterial line, from an oscillometric
sphygmomanometer. Arterial lines were cali-
brated on a daily basis according to the RAH
ICU protocol. Before invasive BP measure-
ments were recorded it was ensured that a
satisfactory tracing was obtained. Percutaneous
oxygen saturation (SpO
2
) was recorded using a
pulse oximeter with a finger or ear probe, afte r
ensuring that a satisfactory tracing was estab-
lished and that the HR on the oximeter was
similar to that seen on the ECG. In addition to
these objective parameters, patient appearance
was documented and the fo llowing noted:
conscious state, respiratory pattern, pallor,
flushing, sweating, clamminess, cyanosis, visible
or patient reported signs of pain, discomfort or
fatigue. Any deterioration in the patient’s con-
dition during the mobilisation treatment was
176
K. STILLER ET AL.
Fig. 1 Overview of safety issues prior to mobilizing acutely ill in-patients (from Stiller and Phillips, 2003).
MOBILISATION AND INTENSIVE CARE PATIENTS 177
recorded and any intervention required in its
management was noted. These outcome mea-
sures were recorded during a baseline period
just prior to the mobilisation treatment, during
each mobility task (within the first 30 seconds of
completion of the task), and within one minu te
of compl etion of the entire mobilisation treat-
ment when the patient had been returned to a
resting position.
Interval data from the different time
periods were compared using the repeated
measures analysis of variance test. When a
significant time effect was found, paired t tests
were used to identify which time periods were
significantly different. Probability values of less
than 0.05 were considered significant.
RESULTS
A total of 160 patients were in the RAH ICU
during the study period, with 31 patients
(19.3%) receiving mobilisation as part of their
physiotherapy management. The 160 patients
received a total of 425 physiotherapy assess-
ments=treatments over the study period, with
69 (16.2%) of these treatments including
mobilisation. There were 129 patients who were
excluded from the study as they did not receive
mobilisation as part of their physiotherapy
management. There were a variety of reasons
for exclusion such as reduced conscious state,
unstable cardiovascular and=or respiratory
status, or other precluding factors (e.g., spinal
or pelvic fracture; see Figure 1).
Table 1 provides descriptive information
and background biochemical and haematolo-
gical data for the 31 patients included in the
study. As can be seen in this table, many of the
patients included in the study had limited
Table 1
Background data for the 31 patients
Sex n (%)
Male 18 (58.1%)
Female 13 (41.9%)
Age (years)
Mean SD 57 15
Range 2081
Primary diagnosis n (%)
Medical 15 (48.4%)
Surgical 12 (38.7%)
Trauma 4 (12.9%)
Past medical history n (%)
Nil relevant 12 (38.7%)
Hypertension 8 (25.8%)
Obesity 4 (12.9%)
Chronic obstructive pulmonary
disease
4 (12.9%)
Ischaemic heart disease 3 (9.7%)
Symptoms pre-treatment n (%)
Nil 24 (77.4%)
Shortness of breath 6 (19.4%)
Restless 1 (3.2%)
Previous mobility n (%)
Independent 31 (100%)
Days post-admission to ICU
Mean SD 29 19.6
Range 171
Intubation and ventilation
status n (%)
Not intubated, spontaneously
ventilating
18 (58.1%)
Tracheostomy, spontaneously
ventilating
6 (19.4%)
Tracheostomy, assisted
ventilation
7 (22.6%)
Haemoglobin (g=dL)
Mean SD 9.1 1.6
Range 7.015.8
Platelet count (cells=mm
3
)
Mean SD 301 170
Range 42742
White cell count (cells=mm
3
)
Mean SD 10,500 3,600
Range 4,40020,100
Body temperature(
+
Celsius)
Mean SD 37.2 0.5
Range 36.038.2
Blood glucose (mmol=L)
Mean SD 7.3 2.5
Range 4.013.6
Weight (kg)
Mean SD 83 34
Range 35160
Pre-treatment PaO
2
=FIO
2
ratio (n ¼ 65)
Mean SD 263 112
Range 124587
100200: n (%) 19 (29.2%)
201300: n (%) 27 (41.5%)
>300: n (%) 19 (29.2%)
Pre-treatment heart rate (n ¼ 69)
Mean SD (bpm) 94.1 14.5
Range (bpm) 69133
<50% age predicted
maximum: n (%)
14 (20.3%)
50 70% age predicted
maximum: n (%)
47 (68.1%)
71 80% age predicted
maximum: n (%)
7 (10.1%)
>80% age predicted
maximum: n (%)
1 (1.4%)
178 K. STILLER ET AL.
cardiac reserve at rest, as indicated by the pre-
treatment HR being more than 50 per cent of
the age predicted maximum on 55 of the 69
occasions (79.7%) of mobilisation (Stiller and
Phillips, 2003; see Figure 1). Marginal respira-
tory reserve at rest was also evident for some
patients, in that the pre-treatment PaO
2
=FIO
2
ratio was less than 300 on 46 of 65 occasions
(70.7%) in patients with available ABGs (Stiller
and Phillips, 2003, see Figure 1). In to tal, 63 of
the 69 mobilisation treatments (91.3 %) were
performed with patients who had marginal
cardiac and=or respiratory reserve at rest
(i.e., pre-treatment HR more than 50% age
predicted maximum and=or PaO
2
=FIO
2
less
than 300).
The 69 mobilisation treatments received by
the 31 patien ts involved:
sitting on the edge of the bed on 39
occasions
sitting on the edge of the bed and standing
on 19 occasions
sitting on the edge of the bed and standing
transfer to a chair on 10 occasions and
sitting on the edge of the bed, standing and
walking on one occasion.
For the purposes of presenting the results (see
Table 2 and Figures 2, 3, and 4), the first
mobility task refers to the first activity during
the mobilisation treatment (in all cases this was
sitting on the edge of the bed). For those
patients who progressed beyond sitting on the
edge of the bed, the second mobility task refers
to the seco nd activity during mobilisation (i.e.,
standing or standing transfer). As only one
patient progressed beyond sitting on the edge
of the bed and standing (i.e., to walking),
data from the walking component of the
mobilisation treatment were not analysed.
Figures 2 to 4 show the mean (SD) values
for HR, BP and SpO
2
over the 69 occasions of
mobilisation at the different time intervals.
A significant change was seen over time for
HR (absolute and percentage age predicted
maximum HR) and for systolic and diastolic BP
(p < 0.001). Using paired t tests, HR (absolute
and percentage age predicted maximum HR)
significantly increased from pre-treatment to the
first mobility task (p < 0.001). A further sig-
nificant increase was seen from the first to the
second mobility task (p < 0.001). Post-treatment,
HR was still significantly increased from the
pre-treatment level (p < 0.001). Similar changes
Table 2
Changes in haemodynamic and respiratory data during the 69 occasions of mobilisation for the 31 patients
Pre-treatment to first
mobility task
First to second
mobility task
Pre-treatment to
post-treatment
Heart rate n ¼ 69 n ¼ 28 n ¼ 69
Fall 12 (17.4%) 6 (21.4%) 13 (18.8%)
No change 4 (5.8%) 0 4 (5.8%)
Increase 53 (76.8%) 22 (78.6%) 52 (75.4%)
Systolic BP n ¼ 61 n ¼ 22 n ¼ 63
Fall 20 mmHg 1 (1.6%) 3 (13.6%) 19 (30.2%)
Fall>20 mmHg 8 (13.1%) 5 (22.7%) 1 (1.6%)
No change 0 4 (18.2%) 4 (6.3%)
Increase 52 (85.2%) 10 (45.5%) 39 (61.9%)
Diastolic BP n ¼ 61 n ¼ 22 n ¼ 63
Fall 10 mmHg 4 (6.6%) 8 (36.4%) 10 (15.9%)
Fall>10 mmHg 0 2 (9.1%) 3 (4.8%)
No change 2 (3.3%) 4 (18.2%) 5 (7.9%)
Increase 55 (90.2%) 8 (36.4%) 45 (71.4%)
SpO
2
n ¼ 69 n ¼ 26 n ¼ 69
Fall < 4% 24 (34.8%) 5 (19.2%) 17 (24.6%)
Fall 4% 10 (14.5%) 3 (11.5%) 7 (10.1%)
No change 20 (29.0%) 7 (26.9%) 19 (27.5%)
Increase 15 (21.7%) 11 (42.3%) 26 (37.7%)
MOBILISATION AND INTENSIVE CARE PATIENTS 179
were seen for systolic and diastolic BP, except
that BP during the second mobility task was not
significantly different from the first mobility
task. Although the changes seen in HR and BP
over time were statistically significant, the mag-
nitude of these changes was generally small in
terms of absolute and relative values, with most
values changing by approximately 10 per cent or
Fig. 2 Heart rate response to mobilisation (means, error bars represent SD).
Fig. 3 Blood pressure response to mobilisation (means, error bars represent SD).
180 K. STILLER ET AL.
less. A fall in SpO
2
was seen during mobilisation,
but this was not sufficient to achieve statistical
significance (p ¼ 0.44).
Table 2 provides the distribution of responses
seen during mobilisation. Although the majority
of patients showed the expected response in HR
and BP (i.e., an increase during mobilisation),
there were a number of pati ents where HR and
BP fell during mobilisation.
The most common change in patient
appearance seen during the mobilisation treat-
ment was an alteration in respiratory pattern
(e.g., increased respiratory rate and=or
increased use of accessory muscles of respira-
tion), which was seen on 10 occasions (14.5%).
On two of the 69 occasions of mobilisation
(2.9%), patients reported dizziness during the
mobilisation treatment, but this was not
accompanied by orthostatic hypotension, nor
did it limit mobilisation or require any direct
medical intervention. Cardiac arrhythmias were
noted pre-treatment on eight occasions
(11.6%)—four cases of atrial fibrillation and
four cases of occasional premature ventricular
contractions. In each instance the cardiac
arrhythmia had been present for some time
and did not require medication, nor did it
affect haemodynamic stability. Therefore
mobilisation was deemed safe to proceed (see
Figure 1). No change in the severity or
frequency of the arrhythmias was noted during
mobilisation.
On three of the 69 occasions of mobilisa-
tion (4.3%), a deterioration in a patient’s con-
dition occurred that required specific inter-
vention. The salient features of the three
patients who deteriorated during mobilisation
are provided in Table 3. In all three cases, the
deterioration was a fall in SpO
2
. In One case
(patient 1 in Table 3), the desaturation occur-
red dur ing the first occasion on which mobili-
sation was attempted. For the other two
patients, the destauration occurred on the
second occasion of mobilisation. For two of the
patients the desaturation occurred while sitting
on the edge of the bed (patients 2 and 3, Table
3) and the other patient (patient 1) desatu-
rated when proceeding from sitting to stand-
ing. In each case the patient required a
temporary increase in FIO
2
, which resulted in
an improvement in SpO
2
and did not necessi-
tate further intervention or termination of the
mobilisation treatment. To determine if there
were any features that were able to predict
patients likely to deteriorate during mobilisa-
tion, the data from the three patients whose
condition deteriorated during mobilisation
were further reviewed. All three patients (see
Table 3) had pre-treatment HRs that were
more than 60 per cent of their age predicted
Fig. 4 Percutaneous saturation response to mobilisation (means, error bars represent SD).
MOBILISATION AND INTENSIVE CARE PATIENTS 181
maximum, suggesting particularly limited car-
diac reserve at rest (see Figur e 1). However, 13
other patients had pre-treatment HRs higher
than 60 per cent of their age predicted max-
imum and did not demonstrate any adverse
effects during mobilisation. Only one of the
three patients (patient 2) had a pre-treatment
BP that woul d be considered abnormal. How-
ever, her BP had been stable at this low level,
without inotropic assistance, for several days
and she required no treatment for the hypo-
tension, therefore mobili sation was deemed
safe to proceed (see Figure 1). As can be seen
from Table 3, this patient showed a marked
increase in BP during mobilisation. However,
this measurement may be inaccurate due to
the position of the arterial line. As far as
oxygenation is concerned, patient 2 had parti-
cularly marginal respiratory reserve pre-treat-
ment (i.e., a PaO
2
=FIO
2
ratio of 145; see Figure
1). However, six other patients had a ratio less
than 145 and did not deteriorate during
mobilisaton. As far as pre-treatment SpO
2
is
concer ned, there were only two of the 69
occasions of mobilisation when this was less
than 90 per cent, one of which was for patient 1
who then went on to desaturate during mobi-
lisation. Therefore, while a pre-treatment SpO
2
of less than 90 per cent seemed to be predictive
of desaturation during mobilisation, it is not
possible to draw firm conclusions from this
small patient sample. No other factors were
able to be identified that could predic t those
patients who deteriorated during mobilisation.
Despite the marginal cardiovascular and=or
respiratory reserve of these three patients (see
Figure 1), mobilisation was undertaken as its
perceived benefits were thought to outweigh
the potential risks.
DISCUSSION
This study found that mobilisation was
associated with significant increases in HR,
systolic and diastolic BP, and a decrease in
SpO
2
. Although the changes were statistically
significant for HR and BP, the magnitude of
the changes was of minor clinical importance.
There were only three episodes of major clin-
ical importance (4.3%) when specific inter-
vention was required during mobilisation to
stabilise haemodynamic and=or respiratory
status, with all three patients responding
quickly to minimal intervention. Thus, mobili-
sation was well tolerated in those patients
deemed suitable for mobilisation, even though
their pre-treatment data suggested limited car-
diac and=or respiratory reserve (see Figure 1).
Table 3
Characteristics of the three patients who deteriorated during mobilisation
Patient 1 Patient 2 Patient 3
Sex=age (years) F=70 F=62 M=74
Primary diagnosis Exacerbation
COPD
Post-operative
respiratory failure
Respiratory
failure
Past medical history COPD, malnutrition Nil CLL
Weight (kg) 35 40 75
Symptoms SOB pre-treatment Nil Nil
Days post-admission 1 56 23
Intubation status Not intubated Tracheostomy Tracheostomy
Ventilation status Nasal speculae Pressure support Pressure support
Pre-treatment PaO
2
=FIO
2
232 145 291
Pre-treatment HR (% age pred max) 66.0 60.8 66.4
Highest HR during mobilisation
(% age pred max)
73.3 55.1 69.2
Pre-treatment BP (mmHg) 145/65 95/51 146/45
BP during mobilisation 150/64 189/100 158/64
Pre-treatment SpO
2
87 92 97
Lowest SpO
2
during mobilisation 78 88 87
182 K. STILLER ET AL.
Although a low incidence of problems
during mobilisation was found in this study, it is
imperative to stress that a comprehensive
screening process (Stiller and Phillips, 2003)
was used to select suitable patients for mobili-
sation. Additionally, appropriate precautions
were taken prior to, during and after mobili-
sation. The screening process presented in flow
chart format in Figure 1 is a simplified version
of the guidelines published by Stiller and
Phillips (2003). In the current study, despite
the majority of patients showing limited pre-
treatment cardiac and=or respiratory reserve
according to the flow chart (see Figure 1), the
perceived benefits of mobilisation were
deemed to outweigh the perceived risks. As is
explained more fully in the complete set of
guidelines (Stiller and Phillips, 2003), the
parameters shown in Figure 1 are not intended
to be contraindications to mobilisation or
interpreted in isolation, but instead should be
used in conjunction with sound clinical judge-
ment. Experienced clinicians are often able to
discern which patients will tolerate mobilisa-
tion despite marginal cardiac and=or respira-
tory reserve at rest. This relies on the ability of
the experienced clinician to take into account
the more objective parameters (see Figure 1)
and also to observe and interpret more sub-
jective factors, such as patient appearance,
conscious state and level of pain and fatigue.
For example, as noted by Stiller and Phillips
(2003), patient appearance (e.g., facial
expression, cyanosis, pallor, flush, clamminess,
sweatiness, anxiety) can provide the discerning
clinician with essential information regarding
how well a patient will tolerate mobilisation—
information that may not be evident with other
measures. With experience, clinicians can syn-
thesise all the information available and dis-
criminate between patients who will or will not
tolerate active mobilisation, despite marginal
reserve. The low incidence of problems in this
study suggests that this screening process,
which includes clinical judgment, can assist in
the identification of patien ts who will tolerate
mobilisation. Additionally, this overview of
safety issues prior to commencing mobilisation
was able to highlight those patients likely to
have potential problems and help identify
which systems were likely to be challenged
during mobilisation.
The haemodynamic responses that most
patients showed during mobilisation were as
anticipated, in that there was a progressive
increase in HR during mobilisation and a return
to near baseline levels at the completion of the
mobilisation treatment (Franklin et al, 2000;
McArdle et al, 1996; Selwyn and Braunwald,
2001). Blood pressure (diastolic and systolic)
showed a similar response to HR. However it was
evident that the increases in BP seen for
patients with invasive arterial lines often seemed
excessive. This is likely to reflect the inaccuracy
of invasive BP measurement when the arterial
line is moved from the position in which it has
been calibrated. The haemodynamic responses
seen during mobilisation in this study were
similar to those reported during respiratory
physiotherapy treatment (Cohen, Horiuchi,
Kemper, and Weissman, 1996; Klein et al, 1988;
Weissman et al, 1984) and other routine ICU
activities (e.g, movement of the body and limbs,
physical examination; Weissman et al, 1984).
It was anticipated that oxygenation of these
acutely ill patients would improve during
mobilisation, due to the expected beneficial
effects of the upright position on lung volumes
and ventilation=perfusion distribution (Dean,
1985; Dean and Ross, 1992a, 1992b; Ross and
Dean, 1992; Wong, 1999). Instead, in this
sample of acutely ill patients, SpO
2
decreased
during the first mobility task and showed a
further decrease during the second mobility
task. This fall in SpO
2
most likely reflects that,
despite the theoretical benefits, the patients’
cardiorespiratory systems could not meet the
increased oxygen demand imposed by the
mobilisation treatment. However, these decrea-
ses did not achieve statistical significance, nor,
as a fall in SpO
2
of four per cent or more is
usually required to be considered clinically sig-
nificant (Franklin et al, 2000; see Figure 1),
would they be considered clinically significant.
It could be argued that the three patients
whose condition deteriorated during mobilisa-
tion should not have been mobilised at all based
on their pre-treatment data (see Figure 1).
MOBILISATION AND INTENSIVE CARE PATIENTS 183
However, for all three patients it was thought
that the potential benefits of mobilisation out-
weighed the potential risks. Furthermore, even
though all three patients desaturated during
mobilisation, they quickly recovered once FIO
2
was increased, which vindicated the decision
to perform mobilisation. Hypothetically, if
increasing the FIO
2
had not improved SpO
2
,
appropriate interventions may have included
terminating the mobilisation treatment and, it
necessary, increasing the level of ventilatory
support. In a similar way that pre-oxygenation
prior to suction has been shown to prevent
suction induced hypoxaemia (Chulay, 1988;
Ciesla, 1996; Mancinelli-Van Atta and Beck,
1992), it is possible that increasing FIO
2
prior to
mobilisation may be beneficial for patients with
marginal oxygenation.
Further research should be undertaken
with similar patient groups to confirm the
findings of this study. This may help to identify
factors that predict which patients are likely to
deteriorate during mobilisation. It may also be
helpful in future research to measure oxyge-
nation dur ing mobilisation using parameters
obtained from ABGs, such as the PaO
2
=FIO
2
ratio, as this takes into account the FIO
2
and
thus more accurately reflects oxygenation and
the underlying respiratory reserve (Stiller and
Phillips, 2003). However, the frequent mea-
surement of ABGs is often impractical in the
clinical setting, whereas SpO
2
, by virtue of
being a non-invasive measurement, provides
instantaneous feedback to the clinician. Addi-
tionally, this study only measured patients for a
short time after the completion of the mobili-
sation treatment, and longer term effects of
mobilisation could be investigated. Although
randomised controlled studies would more
clearly establish the role of mobilisation in the
recovery of acutely ill patients, it may be diffi-
cult to withhold mobilisation from an ethical
viewpoint.
CONCLUSION
This study found that mobilisation of acutely ill
ICU patients resulted in a significant increase
in HR and BP, and a fall in SpO
2
. Although
some changes were statistically significant, the
magnitude of the changes was of little clinical
importance. There were only three episodes
that were deemed of major clinical importance
(4.3%), in that specific intervention was
required. Although most patients demon-
strated marginal cardiac and=or respiratory
function pre-treatment, mobilisation was well
tolerated in this patient sample. Thus, if
appropriate screening procedures and pre-
cautions are taken prior to and during mobili-
sation, acutely ill ICU patients deemed suitable
for mobilisation can be safely mobilised with-
out major deterioration in their clinical status.
Acknowledgments
Special thanks to Naomi Haensel, Shane Patman,
and Louise Wiles fo r th eir helpful comments.
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