Early Mobility, Skin, and Pressure Ulcer Risk Assessment

  • Gian Domenico Giusti
  • Angela Peghetti
  • Irene Comisso
  • Stefano Bambi


The intensive care unit-acquired weakness (ICU-AW) is an important adverse effect due to bed rest in critically ill patients. This kind of complication is a hindrance to the implementation of a fast recovery of patients. It’s mandatory for nurses to implement the ICU-AW prevention through an active collaboration in early patients’ positioning, progressive mobilization, and active collaboration during physiotherapy interventions. The only contraindications to early mobilization are hemodynamic instability, intracranial hypertension, and severe multiple bone injuries. Another major complication related to the bed rest of patients is the development of pressure ulcers (pressure injuries—PIs) in ICU. PIs’ risk assessment using the Braden scale in critical care patients is no longer recommended, since it showed a poor accuracy in predicting PIs, mainly related to the scale lack of ICU-specific risk factors such as MV, hypotension, cardiovascular instability, and ICU-LOS. Even the Cubbin-Jackson scale seems to have important limitations in ICU populations. However, the recent introduction of a new scale called COHMON (conscious level, mobility, hemodynamics, oxygenation, nutrition) index for PIs’ risk assessment seems to be promising.


Bed rest Critical care Early ambulation Muscle weakness Pressure ulcer Pressure injury Prevention 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gian Domenico Giusti
    • 1
  • Angela Peghetti
    • 2
  • Irene Comisso
    • 3
  • Stefano Bambi
    • 4
  1. 1.Intensive Care UnitUniversity Hospital of PerugiaPerugiaItaly
  2. 2.Nurse Staff. Nurse DepartmentAOU “S.Orsola Malpighi”BolognaItaly
  3. 3.University Anesthesia and Intensive Care Unit, University Hospital S. Maria della MisericordiaUdineItaly
  4. 4.Emergency & Trauma ICU, University Hospital CareggiFlorenceItaly

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