ICU Topics > Setting Up for Mobility

Setting Up for Mobility

General Tips

Before the Session

  • Coordinate with the bedside nurse before entering. Confirm timing — avoid overlapping with medications, procedures, wound care, or bathing.

  • If the patient is sedated, ask whether sedation can be lightened or turned off for therapy. Schedule around windows when sedation is reduced to maximize participation.

  • Review activity orders and confirm there are no new restrictions since your last visit.

  • Check isolation precautions — don PPE before entering the room.

  • If the patient has been sitting in the chair each day, coordinate with the nurse: do you want to observe the transfer? Assist? Start in bed and progress to chair? Establish a clear plan.

  • When transferring to a chair for the first time — especially with higher-acuity patients — place a Hoyer lift sling in the chair in advance, in case the nurse needs it for the return transfer.

  • Ensure all drains that can be clamped are clamped and documented prior to any position change. Confirm with nursing which drains require clamping and which must remain open.

During Mobility

  • Organize all lines, wires, and tubes before moving the patient. Reposition them to the side you will be mobilizing toward — generally toward the ventilator if the patient is intubated.

  • Confirm with the nurse which lines can be disconnected or capped to improve ease of movement and ADL participation.

  • Ensure adequate slack in all lines before any position change. Never pull or allow tension on lines during activity.

  • Monitor vitals continuously during the session — note baseline values before starting and watch for trends, not just single numbers. Know your stop criteria before you begin.

  • When alarms sound, pause and assess before continuing. Identify the source (monitor, vent, IV pump) and notify nursing if the cause is unclear or persistent.

  • If the patient shows signs of intolerance (diaphoresis, distress, drop in SpO₂, HR change >20% above baseline), stop activity, return to a supported position, and allow recovery time. See the Considerations & Contraindications page for full stop criteria.

Mobilizing a Patient on Mechanical Ventilation

Before proceeding: If FiO2 ≥0.60 (60%) and/or PEEP ≥10 cmH2O, discuss with the team to confirm medical stability before initiating out-of-bed activity.
  1. Check ETT placement (if orally intubated). Verify the tube is secure and confirm the cm marking at the lip. Document the number and check it again after any position change.
  2. Note baseline vitals and current vent settings before beginning. You need a baseline to detect meaningful changes during the session.
  3. Organize all lines, tubes, and equipment. Trace every line to its insertion site. Move all lines and equipment to the same side you are mobilizing toward — typically toward the ventilator.
    Note: Check the ETT tubing for condensation/water accumulation before moving the patient. Ask the RN or RT to drain it first — condensation drained into the lungs during repositioning is a preventable complication.
  4. Assist with bed mobility and transfers while managing all lines. Ensure adequate slack before every movement. Keep all lines visible and untangled. Never allow tension or pulling on any line during activity.
  5. Monitor continuously throughout. Watch SpO2, HR, RR, and patient comfort. Pause for any alarm and identify the source. Stop the session if stop criteria are met.
  6. If ambulating: Coordinate with nursing and respiratory therapy to transition the patient to a portable ventilator if needed. Organize all equipment in front of the patient — nothing should drag on the floor or catch in wheels or equipment.
    • Typical roles: RT manages the vent, therapist manages the patient and primary lines, RN or rehab aide follows with a wheelchair as backup.
    • Coordinate with PT for co-treatment or handoff if ambulation is the primary goal.

Hodgson et al., 2014; Linke et al., 2020; Oldenburg & Hamby, 2024

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References

Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., ... & Webb, S. A. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), 658. https://doi.org/10.1186/s13054-014-0658-y

Linke, C. A., Chapman, L. B., Berger, L. J., Kelly, T. L., Korpela, C. A., & Petty, M. G. (2020). Early mobilization in the ICU: A collaborative, integrated approach. Critical Care Explorations, 2(4), e0090. https://doi.org/10.1097/CCE.0000000000000090

Oldenburg, H. Y., & Hamby, J. R. (2024). The novice in acute care. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (3rd ed., pp. 927–961). AOTA Press.