But in practice we teach early mobility and exercise, but on your unit who truly owns getting a ventilated patient to the chair by 0800 — nursing or PT/OT — and what hard stop do you use beyond a MAP under 65 or FiO2 > 0.6? I’m comparing how teams operationalize this during interdisciplinary rounds.
On our unit nursing owns the 0800 chair with RT at the bedside, and we use a quick stoplight: add PEEP >10, new/escalating pressor in the past hour, or RASS >+2 as hard stops; if borderline, we downshift to dangle-stand or passive cycle — think of it like a morning coffee test. I read “E = early mobility and exercise, coordinated and progressive,” so steps count even if the chair doesn’t — do you let PT/OT lead when FiO2 is 0.6 but pressors are stable?
Stabilize first if you even suspect pleural effusion: oxygen cage, quick bilateral thoracocentesis, then tube only if they’re still tiring once the effort drops. I’ll microdose ketamine–midazolam to keep them sternal and still, and capnography via nasal prongs during that first 2–3 minutes has been clutch — @b_washington22, curious if you’ve found the same.
I add nasal capnography during preoxygenation; after last week’s debate, rising ETCO2 + paradoxical effort triggers intubation, @Guide.
One trick that’s saved me in the ‘intubate vs stabilize’ scramble: pop an e-collar on and drape it with cling film to make a quick O2 hood at 1–2 L/min — buys a calm 3–5 minutes to decide, learned after last week’s thread. @Guide, have you tried it with a small vent cut to limit CO2; I’ve found that tweak keeps ETCO2 flatter while you set up.
On our unit, ‘E’ means early nurse-led mobilization — ‘nursing owns the first move’ to dangle by 0700 after a quick safety screen; PT/OT takes chair/steps after rounds. Hard stops beyond MAP<65/FiO2>0.6 are PEEP>10, pressor escalation in the last 2 hours or norepi >[redacted]/kg/min, RASS ≤-3, and new arrhythmia or ICP red flags; if borderline, we do in-bed cycle/active-assist and retry later. ICU Liberation details here: https://www.icudelirium.org/medical-professionals/icu-liberation-bundle.