Early Mobilisation and the ABCDEF Approach

There is a rich history underlying early mobilisation of hospitalised and critically ill patients.  However, over time, the pendulum swung away from patient wakefulness and mobility to embrace deep sedation and bedrest among the critically ill.  Such clinical care practices have many harmful and long-lasting physical, cognitive and mental health consequences for survivors of critical illness.  A rapidly expanding body of evidence supports the safety and feasibility of early mobilisation, with potentially important physical and neuropsychological benefits for critically ill patients.

Early mobilisation and rehabilitation is considered within the 2018 Society of Critical Care Medicine (SCCM) Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the ICU (PADIS guidelines).  These PADIS guidelines can be practically implemented through “bundled” approaches to clinical care, such as implementation of the ABCDEF (“A2F”, or “ICU Liberation”) approach to care.  These Guidelines and the ABCDEF approach recognise important interactions between patients’ physical and neuropsychology status in providing clinical care, which are important in humanising clinical practice and improving patient-important outcomes for survivors of critically illness. Through structured quality improvement processes, these principles of care can be introduced into critical care culture, resulting in large and sustained changes in clinical practice for critically ill patients. 

Such changes in practice have profoundly important and synergistic benefits for patients, family members, and clinicians, along with potential for beneficial effects on hospital resource utilisation. As part of humanising critical care, we must expand systematic approaches to implementing, sustaining and expanding early mobilisation and the ABCDEF approach to care.