How should delirium and sedation be addressed before mobilization?

• A. Screen with CAM-ICU, aim for light sedation (RASS -1 to 0), ensure adequate analgesia, and perform spontaneous awakening trials when appropriate.
• B. Screen with CAM-ICU but do not adjust sedation.
• C. Use deep sedation to prevent agitation during mobilization.
• D. Ignore delirium screening and analgesia during mobilization planning.

Answer: (B)

Managing delirium and sedation before mobilization is essential because sedative depth and delirium directly affect safety and the ability to move the patient safely. Start with a delirium screen using CAM-ICU to identify who is delirious and who isn’t. If delirium is present or risk factors exist, address contributing factors and optimize comfort to reduce agitation. Aim for light sedation rather than deep sedation, typically a RASS of -1 to 0, because lighter levels of sedation facilitate participation in mobilization and reduce delirium duration. Ensure analgesia is adequate so pain isn’t driving agitation or withdrawal of effort. When appropriate, perform spontaneous awakening trials to minimize ongoing sedation and better gauge readiness for mobilization. This integrated approach aligns with early mobilization goals and supports safer, more effective activity. Merely screening without adjusting sedation, using deep sedation, or ignoring delirium and analgesia would hinder mobilization and worsen outcomes.