From the Research
For patients hospitalized with pneumonia, activity level should be gradually increased as tolerated, starting with early mobilization within 24-48 hours of admission if hemodynamically stable, as supported by the most recent study 1 which demonstrated improved recovery and reduced complications in ICU patients with severe pneumonia.
Key Considerations
- Patients should begin with sitting at the edge of the bed, then progress to standing, and finally walking short distances with assistance as their condition improves.
- Aim for at least three mobilization sessions daily, with each session lasting 15-30 minutes as tolerated.
- Deep breathing exercises and incentive spirometry should be performed every 1-2 hours while awake to prevent atelectasis and improve lung expansion.
- Rest periods should be scheduled between activities, and oxygen supplementation may be required during exertion to maintain oxygen saturation above 90%.
- Activity should be temporarily reduced if the patient experiences increased shortness of breath, chest pain, dizziness, or fatigue.
Rationale
Early mobilization helps prevent complications like venous thromboembolism, muscle weakness, and hospital-acquired pneumonia while improving respiratory function through better ventilation and secretion clearance. As the patient improves clinically (decreased fever, improved respiratory rate and oxygen requirements), activity can be progressively increased with the goal of returning to baseline function before discharge. The use of noninvasive respiratory supports, such as noninvasive ventilation and high-flow nasal cannula oxygen therapy, may also be beneficial in patients with severe community-acquired pneumonia, as suggested by recent studies 2. However, the optimal ventilatory strategy in this setting is uncertain and requires further research.
Prioritization of Outcomes
The primary goal of activity level management in patients with pneumonia is to minimize morbidity, mortality, and improve quality of life. By prioritizing early mobilization and gradual increase in activity level, healthcare providers can help prevent complications, improve respiratory function, and ultimately reduce the risk of long-term disability and mortality. The most recent and highest quality study 1 provides strong evidence for the effectiveness of optimized individualized nursing interventions, including early mobilization, in improving clinical outcomes in ICU patients with severe pneumonia.