title: Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults.
abstract: BACKGROUND
  The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients.
  
  
  METHODS
  A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients.
  
  
  RESULTS
  Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations.
  
  
  CONCLUSIONS
  Consensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events.
authors.affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. carol.hodgson@monash.edu.|Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia. carol.hodgson@monash.edu.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Hodgson
authors.affiliation: Department of Physiotherapy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia. kathy.stiller@health.sa.gov.au.
authors.forename: Kathy
authors.initials: K
authors.lastname: Stiller
authors.affiliation: Outcomes After Critical Illness & Surgery (OACIS) Group, Division of Pulmonary & Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA. dale.needham@jhmi.edu.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.affiliation: Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia. c.tipping@alfred.org.au.
authors.forename: Claire J
authors.initials: CJ
authors.lastname: Tipping
authors.affiliation: School of Physiotherapy & Exercise Science, Curtin University of Technology, Kent Street, Bentley, Western Australia, 6102, Australia. harroldm@hotmail.com.
authors.forename: Megan
authors.initials: M
authors.lastname: Harrold
authors.affiliation: School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, 5001, Australia. claire.baldwin@unisa.edu.au.|Physiotherapy Department, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia. claire.baldwin@unisa.edu.au.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Baldwin
authors.affiliation: Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia. S.Bradley@alfred.org.au.
authors.forename: Scott
authors.initials: S
authors.lastname: Bradley
authors.affiliation: Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. Sue.berney@austin.org.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Berney
authors.affiliation: The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia. Lawrence.Caruana@health.qld.gov.au.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Caruana
authors.affiliation: Faculty of Health, University of Technology, Sydney (UTS), 235 Jones Street, Broadway, New South Wales, 2007, Australia. doug.elliott@uts.edu.au.
authors.forename: Doug
authors.initials: D
authors.lastname: Elliott
authors.affiliation: Physiotherapy Department, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia. Margot.Green@act.gov.au.
authors.forename: Margot
authors.initials: M
authors.lastname: Green
authors.affiliation: Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. Kimberley.haines@svhm.org.au.|Department of Physiotherapy, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. Kimberley.haines@svhm.org.au.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Haines
authors.affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. lisa.higgins@monash.edu.
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Higgins
authors.affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. maija.kaukonen@hus.fi.|Department of Anaesthesiology and Intensive Care, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, Finland. maija.kaukonen@hus.fi.
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.affiliation: Intensive Care Unit, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia. Anne.Leditschke@act.gov.au.|Australian National University Medical School, The Canberra Hospital, Hospital Road, Garran, Australian Capital Territory, 2606, Australia. Anne.Leditschke@act.gov.au.
authors.forename: Isabel Anne
authors.initials: IA
authors.lastname: Leditschke
authors.affiliation: Physiotherapy Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102, Australia. marc.nickels@health.qld.gov.au.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Nickels
authors.affiliation: Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. j.paratz@uq.edu.au.|School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4215, Australia. j.paratz@uq.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
authors.affiliation: School of Physiotherapy, The University of Notre Dame Australia, Fremantle Campus, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia. shane.patman@nd.edu.au.
authors.forename: Shane
authors.initials: S
authors.lastname: Patman
authors.affiliation: Department of Physiotherapy, Western Health, Western Hospital, Gordon Street, Footscray, Victoria, 3011, Australia. elizabeth.skinner@wh.org.au.|Department of Physiotherapy, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria, 3199, Australia. elizabeth.skinner@wh.org.au.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Skinner
authors.affiliation: Capital and Coast District Health Board, Intensive Care Unit, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand. paul.young@ccdhb.org.nz.|Medical Research Institute of New Zealand, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand. paul.young@ccdhb.org.nz.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Young
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA. Jzanni1@jhmi.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zanni
authors.affiliation: Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia. l.denehy@unimelb.edu.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. steve.webb@uwa.edu.au.|School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6006, Australia. steve.webb@uwa.edu.au.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Webb
mesh_terms: D032921:Consensus; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness / Q000453:epidemiology / Q000534:rehabilitation*; D004434:Early Ambulation / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012121:Respiration, Artificial / Q000379:methods / Q000592:standards*