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. 2019 Oct-Dec;31(4):434-443.
doi: 10.5935/0103-507X.20190084.

Brazilian Guidelines for Early Mobilization in Intensive Care Unit

[Article in Portuguese, English]
Esperidião Elias Aquim  1 , Wanderley Marques Bernardo  2   3 , Renata Ferreira Buzzini  3 , Nara Selaimen Gaertner de Azeredo  1 , Laura Severo da Cunha  1 , Marta Cristina Pauleti Damasceno  1 , Rafael Alexandre de Oliveira Deucher  1 , Antonio Carlos Magalhães Duarte  1 , Juliana Thiemy Librelato  1 , Cesar Augusto Melo-Silva  1 , Sergio Nogueira Nemer  1 , Sabrina Donatti Ferreira da Silva  1 , Cleber Verona  1
Affiliations

Brazilian Guidelines for Early Mobilization in Intensive Care Unit

[Article in Portuguese, English]
Esperidião Elias Aquim et al. Rev Bras Ter Intensiva. 2019 Oct-Dec.

Abstract
in English, Portuguese

Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.

A imobilidade pode causar várias complicações que influenciam na recuperação de doentes críticos, incluindo atrofia e fraqueza muscular esquelética. Esse efeito pode ser amenizado com a realização de mobilização precoce. Seis questões primordiais nortearam essa pesquisa: É segura? Quem é o candidato à mobilização precoce? Quais são as contraindicações? Qual a dose adequada e como defini-la? Quais os resultados obtidos? Quais os indicadores prognósticos em sua utilização? O objetivo desta diretriz foi elaborar um documento que reunisse recomendações e sugestões baseadas em níveis de evidência sobre a mobilização precoce do paciente crítico adulto, visando melhorar o entendimento sobre o tema, com impacto positivo no atendimento aos pacientes. Esta diretriz foi desenvolvida com base em uma revisão sistemática de artigos, utilizando a estratégia de busca no modelo PICO, conforme recomendado pelo Projeto de Diretrizes da Associação Médica Brasileira. Foram selecionados ensaios clínicos randomizados, estudos de coortes prognósticos, revisões sistemáticas com ou sem metanálise, sendo as evidências classificadas segundo Oxford Centre for Evidence-based Medicine - Levels of Evidence. Em todas as questões abordadas, foram encontradas evidências suficientes para a realização da mobilização precoce de forma segura e bem definida, com indicadores prognósticos que evidenciam e recomendam a técnica. A mobilização precoce está associada a melhores resultados funcionais, devendo ser realizada sempre que indicada. É segura e deve ser meta de toda equipe multidisciplinar.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Design of the selected studies.
See this image and copyright information in PMC

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