TABLE 3.

Summary of Studies in Which Mechanical Ventilator Were Adjusted During Early Mobilization

References	Study Design	Sample	Type of Mobilization Intervention	Ventilatory Mode /Mechanical Ventilation Brand and Model	Respiratory Support Adjustments During Mobilization	Metabolic/Respiratory Real-Time Variables Measured
Black et al (40)	Observational study	26 mechanically ventilated via tracheostomy from a medical-surgical ICU.	SOEOB, balance activities, standing, transferring and walking. Patients were encouraged to achieve their maximum functional level following the Functional Status Score for the ICU activities.	None specified	PS level adjustment.There were no Fio2 adjustments.	RR, VE, Vo2, Co2 production, and respiratory exchange ratio.
Akoumianaki et al (13)	Cross-over study	10 mechanically ventilated from a medical-surgical ICU. Most patients had a tracheostomy.	Leg cycling (MOTOmed Letto 2; RECK-Technik, Betzenweiler, Germany): The intensity was selected according to a prior incremental workload test to determine the maximum resistance level capacity. Cycling started from passive mobilization and the resistance was gradually increased based on patient’s tolerance to cycle between 30 and 60 rpm.	Servo I, Maquet, Solna, Sweden PSV and NAVA Puritan Bennett 840, Covidien, Mansfield, MA: PSV and PAV+	PS level was set to attain Vt 6–8 mL/kg. The NAVA/PAV support was titrated to attain the same mean airway pressure that PSV.Flow triggering was set as the most sensitive possible evading autotriggering on PSV/PAV, and 0.5µV on NAVA.Cycling-off criterion was 25% (40% for chronic obstructive pulmonary disease) on PSV, 3 L/min on PAV and 70% on NAVA.PEEP remained at the same level and RR ≤ 30 beats/min.Fio2 was titrated to attain Spo2 > 95%.	Vo2, Vt, VE, Spo2, RR, and asynchrony index.
Kho et al (48)	Observational study	33 mechanically ventilated from a medical-surgical ICU (96% via endotracheal tube and 4% via tracheostomy).	Leg cycling (RT-300 supine cycle; Restorative Therapies, Baltimore, MD): 30 min of leg cycling with an additional 1 min cool down, starting with passive cycling using 5 rpm. Patients were encouraged as much active cycling as possible using low resistance.	None specified	Fio2 was adjusted to attain Spo2 > 88%.The mean Fio2 used pre during and after cycling ranged from 37.3% to 38.8%.	Spo2 and asynchrony
Chen et al (16)	Observational study	15 patients who were undergoing prolonged mechanical ventilation (between 24 and 114 mechanical ventilation days).	Upper extremity ergometer test (Active Passive Train, Tzora Co, Kibbutz Tzora, Israel) in upright bed position. Constant-load, symptom-limited exercise test with fixed resistance (approximately 10W) until intolerable shortness of breath, discomfort, or exhaustion.	PSV (brand/model not specified)	Ventilator mode was shifted from A/C to PSV.Three PS levels were titrated: baseline PS level, PS level +2 cm H2O, and PS level +4 cm H2O.PEEP and Fio2 were not changed throughout the study.	Spo2 and RR
Ko et al (49)	Observational study	8 ECMO patients (one venoarterial ECMO and seven venovenous ECMO).	PROM, neuromuscular electrical stimulation, sitting in reclined bed or on SOEOB, strengthening using elastic band in sitting position, standing out of bed or marching in place with or without device, and assisted walking.	None specified	As needed during exercise, perfusionist and respiratory therapist performed ECMO and ventilatory management, respectively, including adjustments of Fio2, ECMO blood flow, and sweep gas flow.	Spo2, RR, and ECMO blood flow
Mah et al (34)	Clinical trial (quazi-experimental trial)	28 mechanically ventilated from a surgical ICU.	Stepwise fashion based on physical assessment and clinical condition using a progressive five-level activity protocol ranged from PROM for unconscious patient to walking without assistance.	Volume-controlled ventilation and PSV (brand/model not specified)	Increased PS level or place on A/C starting 30 min before and continue 30 min after activity.Increased Fio2 by 20% before activityDefer weaning during mobility	None reported
Bailey et al (47)	Observational study	103 patients with mechanical ventilation for > 4 d from a respiratory ICU.	Progressive mobility and walking including SOEOB without back support, sit in a chair after transfer from the hospital bed, and ambulate with or without assistance.	A/C (brand/model not specified)	A pre-/postactivity rest period with A/C for 30 min as needed.Fio2 was increased by 20% before initiation.Defer weaning during mobility.	Spo2

A/C = assist-control mode, ECMO = extracorporeal membrane oxygenation, NAVA = neurally adjusted ventilatory assist, PAV = proportional assist ventilation, PEEP = positive end-expiratory pressure, PROM = in-bed passive exercise, PS = pressure support, PSV = pressure support ventilation, RR = respiratory rate, SOEOB = sitting on the edge of the bed, Spo₂ = pulse oximetry saturation, VE = minute ventilation, Vo₂ = O₂ consumption, Vt = tidal volume.