Clinical algorithm for the passive mobilization of an unresponsive patient

1
Clinical algorithm for the passive mobilization
of an unresponsive patient
Next step in the algorithm
2
On admission to unit

• Develop an individually designed mobility plan
  with outcomes for each patient in consultation
  with rest of the team.
• Monitor daily and provide feedback
• (Nava 2000 Nava 2002 Thomas 2002 Vollman 2004)
• Recommendation 1

Next step in the algorithm
3
Does patient present with any

• Neurological contra indications?
• Orthopedic contra indications?
• Recent SSG?

YES
NO
4

• Discuss with interdisciplinary team
• Decide on a specific mobility plan for the
  patient including outcome measures and monitor
  accordingly

Back to algorithm
5
Patient has sufficient cardiovascular reserve?

• MAP gt 60mmHg
• No new cardiac arythmias visible on ECG
• HR lt 75 APM
• Low dose inotrope support
• Dopamine lt10mcg/kg/min
• Nor/adrenalinelt01mcg/kg/min
• EXPERT OPINION
• Thomas et al 2006

YES
NO
6
Initiate basic elements of a mobility plan

• Two hourly change of position supine quarter
  turn (Topp 2002 Thomas 2006 Krishnagopalan et
  al 2002)
• Nurse in 30-45 degrees head up position (supine)
  (I RCT Dodek et al 2004)
• Passive movement of upper and lower extremities
  once daily through full range (Morris 2007
  Winkelman 2007 Nava 2002)
• EXPERT OPINION
• Topp et al 2002 Thomas et al 2006
  Krishnagopalan et al 2002 Morris 2007 Winkelman
  2007 Nava 2002

Previous step in the algorithm