Decision Making for Initiating Early Mobilization After Cardiothoracic Surgery

Vocabulary and clinical criteria flashcards for determining the appropriateness and contraindications of initiating early in-bed and out-of-bed mobilization after cardiothoracic surgery.

Indicated Respiratory Frequency Range

A respiratory frequency of $8\text{--}30\,\text{breaths/min}$ indicates that out-of-bed mobilization is appropriate.

Relatively Contraindicated Respiratory Frequency Range

A respiratory frequency of $30\text{--}45\,\text{breaths/min}$ is a relative contraindication for out-of-bed mobilization.

Indicated Fraction of Inspired Oxygen (FiO2)

An $\text{FiO}_2 \le 60\%$ indicates that out-of-bed mobilization is appropriate.

Relatively Contraindicated Fraction of Inspired Oxygen (FiO2)

An $\text{FiO}_2 > 60\%$ is a relative contraindication for out-of-bed mobilization.

Indicated Positive End-Expiratory Pressure (PEEP)

A PEEP level of $<10\,\text{cm H}_2\text{O}$ indicates that out-of-bed mobilization is appropriate.

Relatively Contraindicated Positive End-Expiratory Pressure (PEEP)

A PEEP level of $10\text{--}16\,\text{cm H}_2\text{O}$ is a relative contraindication for out-of-bed mobilization.

Indicated Oxygen Saturation

An oxygen saturation of $\ge 90\%$ indicates that out-of-bed mobilization is appropriate.

Oxygen Saturation Absolute Contraindication

An oxygen saturation of $<90\%$ is an absolute contraindication for out-of-bed mobilization and a relative contraindication for in-bed mobilization.

Indicated Heart Rate (HR) Range

A heart rate of $40\text{--}130\,\text{beats/min}$ indicates that out-of-bed mobilization is appropriate.

Bradycardia Absolute Contraindication

Bradycardia ($<40\,\text{beats/min}$) requiring pharmacological treatment or emergency pacemaker placement is an absolute contraindication for in- and out-of-bed mobilization.

Bradycardia Relative Contraindication

Bradycardia not requiring pharmacological treatment and not awaiting emergency pacemaker placement is a relative contraindication for out-of-bed mobilization.

Tachyarrhythmia Absolute Contraindication

Tachyarrhythmia with $\text{HR} > 150\,\text{beats/min}$ (e.g., rapid atrial fibrillation) is an absolute contraindication for out-of-bed mobilization, but not for in-bed mobilization.

Tachyarrhythmia Relative Contraindication

Tachyarrhythmia with $\text{HR}: 130\text{--}150\,\text{beats/min}$ is a relative contraindication for out-of-bed mobilization.

Indicated Mean Arterial Pressure (MAP)

A mean arterial pressure of $60\text{--}110\,\text{mmHg}$ indicates that out-of-bed mobilization is appropriate.

Indicated Systolic Blood Pressure (SBP)

A systolic blood pressure of $90\text{--}170\,\text{mmHg}$ indicates that out-of-bed mobilization is appropriate.

MAP > 60 mmHg with High-Level Inotropic Support

An absolute contraindication for out-of-bed mobilization, but not for in-bed mobilization.

MAP < 60 mmHg

An absolute contraindication for out-of-bed mobilization, but not for in-bed mobilization.

MAP > 60 mmHg with Moderate-Level Vasoactive Support

A relative contraindication for out-of-bed mobilization.

Indicated Level of Sedation (RASS)

A RASS score of $0$ (alert) or $-1$ (drowsy) indicates that out-of-bed mobilization is appropriate.

Relatively Contraindicated Level of Sedation (RASS)

A RASS score of $-2$ (lightly sedated) is a relative contraindication for out-of-bed mobilization.

Absolutely Contraindicated Level of Sedation (RASS)

A RASS score range from $-3$ to $-5$ (moderately/deeply sedated or unarousable) is an absolute contraindication for out-of-bed mobilization.

Indicated Level of Agitation (RASS)

A RASS score of $0$ (calm) or $+1$ (restless) indicates that out-of-bed mobilization is appropriate.

Relatively Contraindicated Level of Agitation (RASS)

A RASS score of $+2$ (agitated) is a relative contraindication for out-of-bed mobilization.

Absolutely Contraindicated Level of Agitation (RASS)

A RASS score range from $+3$ to $+4$ (very agitated or combative) is an absolute contraindication for out-of-bed mobilization.

Indicated Intracranial Pressure (ICP)

An intracranial pressure of $<20\,\text{mmHg}$ indicates that out-of-bed mobilization is appropriate.

Intracranial Hypertension (ICP)

An $\text{ICP} \ge 20\,\text{mmHg}$ is an absolute contraindication for out-of-bed mobilization.

CAM-ICU Indication

A negative CAM-ICU assessment indicates that out-of-bed mobilization is appropriate.

Absolute Medical Contraindications (In- and Out-of-Bed)

Ongoing cardiac ischemia (persistent chest pain), active bleeding (e.g., from operation), and unstable fracture are absolute contraindications for both in- and out-of-bed mobilization.

Femoral Intra-Aortic Balloon Pump Guidelines

Out-of-bed mobilization is not indicated, but in-bed mobilization is possible while avoiding hip flexion.

Pulmonary Artery Catheters Guidelines

Relative contraindication for out-of-bed mobilization, but indicated for in-bed mobilization.

Fever or Hypothermia Guidelines

Fever or hypothermia are relative contraindications for both in- and out-of-bed mobilization.

Known or Suspected DVT Guidelines

Known or suspected deep vein thrombosis (DVT) is a relative contraindication for both in- and out-of-bed mobilization.