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Early mobilization in the pediatric intensive care unit: a systematic review
Beth Wieczorek1, Christopher Burke1, Ahmad Al-Harbi1
1Department of Pediatric Anesthesiology and Critical Care Medicine, Charlotte Bloomberg Children's Center, Baltimore, MD, USA.
Insights
Early rehabilitation in the pediatric intensive care unit (PICU) is safe and feasible, potentially reducing morbidity for critically ill children. Further research is needed to establish protocols and identify outcome measures for early mobilization in the PICU.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Therapy
- Evidence Synthesis
Background:
- Mechanical ventilation and sedatives in the pediatric intensive care unit (PICU) contribute to significant patient morbidity.
- Early mobilization during critical illness may mitigate this morbidity.
- Current evidence on rehabilitation therapies in the PICU requires systematic review to guide practice and research.
Purpose of the Study:
- To systematically review existing evidence on rehabilitation therapies for children in the PICU.
- To identify knowledge gaps and future research directions for early mobilization in the PICU.
- To summarize findings on the safety, feasibility, and outcomes of early rehabilitation.
Main Methods:
- Comprehensive database searches (PubMed, CINAHL, EMBASE) using controlled vocabulary and keywords.
- Independent data abstraction and quality assessment by two reviewers.
- Categorization of included studies based on outcomes: safety/feasibility, functional outcomes, and length of stay.
Main Results:
- Synthesis of six studies (five from search, one from expert query) indicates early rehabilitation in the PICU is safe and feasible.
- Potential short- and long-term benefits of early rehabilitation were observed.
- Identified barriers include institutional, provider, and patient-related factors.
Conclusions:
- Early rehabilitation in the PICU is a safe and feasible intervention with potential benefits for critically ill children.
- Barriers to implementing early rehabilitation need to be addressed.
- Future research should focus on developing early rehabilitation protocols and defining appropriate outcome measures for the PICU setting.
Abstract:
Children admitted to the pediatric intensive care unit (PICU) can experience significant morbidity as a consequence of mechanical ventilation and sedative medications. This morbidity could potentially be decreased with the implementation of activities to promote early mobilization during critical illness. The objective of this systematic review is to summarize the current evidence regarding rehabilitation therapies in the PICU and to highlight the knowledge gaps and avenues for future research on early mobilization in the PICU. Using a combination of controlled vocabulary and key word terms PubMed, CINAHL, and EMBASE databases were searched; no limiters were imposed on search strategies. Two reviewers abstracted data and assessed quality independently. From the 1928 articles identified in the search 168 abstracts were identified for full text review. Fifty-nine articles were chosen for data extraction and five were identified for inclusion in review. A sixth article was identified through expert clinician query. The studies were categorized into three groups based on the outcomes discussed: safety and feasibility, functional outcomes, and length of stay. A synthesis of the studies indicates that early rehabilitation in the PICU is safe and feasible with potential short and long-term benefits. Institutional, provider and patient-related barriers to initiation of early rehabilitation in the PICU are identified. Recommendations for future investigation include early rehabilitation protocols for children hospitalized in the PICU and identification of outcome measures.
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