CAM-ICU screens for delirium in critically ill patients. Delirium is an acute, fluctuating disturbance of attention and awareness that ICU patients can develop from illness, medications, or sleep disruption. The CAM-ICU looks for four elements: an acute change or fluctuating course, inattention, and either altered level of consciousness or disorganized thinking. If the patient shows an acute change or fluctuation plus inattention and one of the other two features, delirium is present. This tool is specifically designed for ICU use, including patients who are intubated and nonverbal, and it can be performed quickly at the bedside after brief training. It’s not intended to assess pain, depression, or neuromuscular weakness, which are evaluated with other instruments.

Mobilization safety hinges on keeping oxygenation stable during activity and avoiding high ventilator support unless necessary. The best guideline is to ensure the patient is saturating adequately (SpO2 around or above 92%), while the amount of supplemental oxygen and airway pressure support is kept moderate (FiO2 not exceeding about 0.6 and PEEP around 10 cm H2O or less). This combination indicates the patient has enough oxygen reserve to tolerate movement without desaturating, and their lung mechanics aren’t so severely impaired that mobilization would pose undue risk. The option with SpO2 ≥ 92% on FiO2 ≤ 0.6 and PEEP ≤ ~10 cm H2O fits this balance: SpO2 is above the commonly accepted safety threshold, FiO2 is moderate, and PEEP is not excessively high, suggesting stability during activity. Other choices align less well with typical mobilization safety criteria. Some impose a stricter SpO2 target or a lower FiO2, which can be overly conservative and not reflect a patient’s actual stability. Some permit a high FiO2 (like 0.8), which often indicates significant respiratory support and increased risk during movement, making mobilization less appropriate.

Phase three focuses on ambulation beyond the patient’s room, moving from seated and in-room gait tasks to walking in the hallway or outside the room. This stage demonstrates that the patient can tolerate functional walking in a broader space, with appropriate safety measures and supervision, after earlier steps have established safe transfers and in-room gait. It requires stable vitals, adequate oxygenation, and support as needed, and it leads toward more advanced mobility activities though it stops short of discharge-level tasks or formal strength training with equipment. That’s why walking out of the room is the best description for this phase.

With a RASS score of -5 to -4, the patient is deeply sedated and largely unresponsive to voice. In this state, active participation in therapy isn’t possible, so the most appropriate intervention is passive range of motion. Passive ROM helps maintain joint mobility and prevent contractures without requiring muscle activation or patient cooperation. Active ROM with resistance would need patient effort and strength, which aren’t feasible here. ADLs training and ambulation require higher levels of arousal and functional capability, which are not present at this sedation level. As sedation is lighter and the patient becomes more alert, therapy can progress to more active interventions as appropriate.