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Understanding Critically Ill Patients Hemodynamic Response to Mobilization: Using the Evidence to Make It Safe and Feasible

Vollman, Kathleen M. MSN, RN, CCNS, FCCM, FAAN

doi: 10.1097/CNQ.0b013e3182750767
Original Articles

In today's critical care environment, we face a difficult but essential task. We must provide comprehensive, compassionate, complex, technological care without causing harm to our patients. To foster a patient-safe environment, we must examine care practices and processes to reduce the chance of error. Successful early mobilization of critically ill patients can reduce several complications including atelectasis and ventilator-associated pneumonia and shorten ventilator time along with cognitive and functional limitations that linger 1 to 5 years after discharge from the intensive care unit. A long-standing challenge to successful mobilization of critically ill patients is the safety concern of hemodynamic instability. An in-depth exploration of what happens to a critically ill patient physiology during mobilization was done to foster a better understanding of strategies that promote adaptation. The article examines the evidence supporting the need to assess readiness for mobilization to reduce the risk of adverse events. Evidence-based tools and techniques to help clinicians prevent hemodynamic instability before, during, and after in-bed or out-of-bed mobilization are discussed. With safety serving as the overriding goal, we can overcome the barriers and succeed in creating and sustaining a culture of early progressive mobility programs within the intensive care unit.

Advancing Nursing LLC, Northville, Michigan.

Correspondence: Kathleen M. Vollman, MSN, RN, CCNS, FCCM, FAAN, Advancing Nursing LLC, 17139 Victor Dr, Northville, MI 48168 (kvollman@comcast.net).

The author is on the speakers bureau and consult with Hill-Rom Inc and Sage Products Inc.

© 2013 Lippincott Williams & Wilkins, Inc.