Respiratory Support Adjustments in Ventilated Patients Performing Early Mobilisation A Pilot Observational Service Evaluation

Early mobilisation in the critical care unit is an accepted intervention to prevent the physical and non-physical morbidity associated with bed rest, mechanical ventilation, and critical illness. When early mobilisation is performed with patients who remain mechanically ventilated, the anticipated increase in exercise induced ventilatory demand (or work of breathing) can be offset by adjusting select mechanical ventilation variables for the duration of the exercise/mobilisation task. Gonzalez-Seguel and colleagues (2021) recently published a scoping review to explore the nature of “respiratory support adjustments” during early mobilisation of ventilated patients which identified limited published reports and no English language guidelines to describe the practice. In the scoping review, seven published articles were identified that reported mechanical ventilator adjustments during early mobilisation of which three (3) detailed continuous arm or leg ergometry [1-3]. The remaining four (4) reports detailed progressive functional mobilisation consistent with the early mobilisation practice observed in most United Kingdom critical care units [4-7]. Ventilator adjustments in these later reports were described as either increases in pressure support or increases in FiO₂, or a combination of these adjustments. The ventilation mode and settings in these reports were inconsistently described and the clinical reasoning underlying the adaptations never explored.