. 2019 Nov 27;7:53. doi: 10.1186/s40560-019-0404-2

Table 4.

Multihospital common early mobilization protocol

Level 1 respiratory (RASS − 5 approximately to – 3)	Level 2 HOB (RASS ≥ − 3)	Level 3 sitting (RASS ≥ − 1)	Level 4 standing (RASS ≥ 0)	Level 5 gait (RASS ≥ 0)
Physical therapy □ Passive ROM exercise □ Respiratory physical therapy	Physical therapy □ Positioning □ Passive ROM exercise □ Active ROM exercise □ Respiratory physical therapy □ Continuous lateral rotation therapy	Physical therapy □ Positioning □ Passive ROM exercise □ Active ROM exercise □ Sitting at side of bed □ Rising from the supine position	Physical therapy □ Positioning □ Passive ROM exercise □ Active ROM exercise □ Standing at side of bed □ Stand and pivot to a chair	Physical therapy □ Positioning □ Passive ROM exercise □ Active ROM exercise □ Walk with assistance □ Walk independently
Positioning □ Posture change □ HOB ≤ 45 degrees	Positioning □ Posture change □ HOB ≥ 60	Positioning □ Posture change □ HOB ≥ 60	Positioning □ Posture change □ HOB ≥ 60	Positioning □ Posture change □ HOB ≥ 60
Step up criterion □ Oxygenation/hemodynamic stability □ Can withstand posture change □ Can withstand HOB ≤ 45 degrees	Step up criterion □ Can withstand supplementary motion of physical therapy □ Can withstand HOB ≤ 60 degrees □ Anti-gravity movement possible	Step up criterion □ Can endure the active movement of physical therapy □ Can withstand HOB ≤ 60 degrees □ Can withstand sitting at side of bed	Step up criterion □ All exercise can be carried out □ Can withstand partial weight standing	Step up criterion □ Increase walking distance gradually
Step up criterion to level 3 or higher are defined as: RASS − 1 to + 2, BPS ≤ 3 or NRS ≤ 5, SpO₂ ≥ 91%, FIO₂ > 0.6, respiratory rate < 30 times/min, systolic blood pressure 90 to 180 mmHg, mean blood pressure 65 to 110 mmHg, heart rate 60 to 120 times/min, there were no new arrhythmias, no additional administration of vasopressors, no bleeding, no wound with the possibility of separation, and no unstable fracture.

Level 1 respiratory (RASS − 5 approximately to – 3)

Level 2 HOB (RASS ≥ − 3)

Level 3 sitting (RASS ≥ − 1)

Level 4 standing (RASS ≥ 0)

Level 5 gait (RASS ≥ 0)

Physical therapy

□ Passive ROM exercise

□ Respiratory physical therapy

Physical therapy

□ Positioning

□ Passive ROM exercise

□ Active ROM exercise

□ Respiratory physical therapy

□ Continuous lateral rotation therapy

Physical therapy

□ Positioning

□ Passive ROM exercise

□ Active ROM exercise

□ Sitting at side of bed

□ Rising from the supine position

Physical therapy

□ Positioning

□ Passive ROM exercise

□ Active ROM exercise

□ Standing at side of bed

□ Stand and pivot to a chair

Physical therapy

□ Positioning

□ Passive ROM exercise

□ Active ROM exercise

□ Walk with assistance

□ Walk independently

Positioning

□ Posture change

□ HOB ≤ 45 degrees

Positioning

□ Posture change

□ HOB ≥ 60

Positioning

□ Posture change

□ HOB ≥ 60

Positioning

□ Posture change

□ HOB ≥ 60

Positioning

□ Posture change

□ HOB ≥ 60

Step up criterion

□ Oxygenation/hemodynamic stability

□ Can withstand posture change

□ Can withstand HOB ≤ 45 degrees

Step up criterion

□ Can withstand supplementary motion of physical therapy

□ Can withstand HOB ≤ 60 degrees

□ Anti-gravity movement possible

Step up criterion

□ Can endure the active movement of physical therapy

□ Can withstand HOB ≤ 60 degrees

□ Can withstand sitting at side of bed

Step up criterion

□ All exercise can be carried out

□ Can withstand partial weight standing

Step up criterion

□ Increase walking distance gradually

Step up criterion to level 3 or higher are defined as:

RASS − 1 to + 2, BPS ≤ 3 or NRS ≤ 5, SpO₂ ≥ 91%, FIO₂ > 0.6, respiratory rate < 30 times/min, systolic blood pressure 90 to 180 mmHg, mean blood pressure 65 to 110 mmHg, heart rate 60 to 120 times/min, there were no new arrhythmias, no additional administration of vasopressors, no bleeding, no wound with the possibility of separation, and no unstable fracture.

RASS Richmond Agitation-Sedation Scale, ROM range of motion, HOB head of bed, BPS behavioral pain scale, NRS numeric rating scale