Development and implementation of an early mobility program for mechanically ventilated pediatric patients

Area of Science:

• Pediatric Critical Care Medicine
• Rehabilitation Medicine

Background:

• Intensive care unit acquired weakness (ICU-AW) and Post-Intensive Care Syndrome (PICS) affect both adult and pediatric patients.
• Early mobility (EM) is a strategy used in adult ICUs to combat ICU-AW and PICS.
• Evidence suggests children also experience detrimental effects from prolonged immobility in the ICU.

Purpose of the Study:

• To develop and implement an early mobility (EM) protocol for pediatric patients requiring invasive mechanical ventilation.
• To assess the safety and feasibility of EM in a pediatric intensive care unit (PICU) population.

Main Methods:

• A multidisciplinary committee designed and implemented an EM protocol in a quaternary care PICU.
• Patient tolerance and serious adverse events were prospectively monitored using a quality database.
• Serious adverse events were defined as unplanned extubation, hemodynamic instability, line displacement, or cardiopulmonary arrest.

Main Results:

• A total of 74 pediatric patients underwent 130 EM sessions between December 2013 and October 2016.
• No serious adverse events were recorded during the study period.
• Minor events included two episodes of oxygen desaturation and one instance of nasogastric tube displacement, both managed effectively.

Conclusions:

• Early mobility is achievable and safe in a quaternary care PICU setting for mechanically ventilated children.
• A multidisciplinary approach and adequate staff training are crucial for successful EM implementation.
• Further research is warranted to elucidate the physical and neurocognitive benefits of EM in pediatric populations.