Early Mobilization in Critically Ill Children: A Systematic Review

Area of Science:

• Pediatric Critical Care Medicine
• Rehabilitation Therapy
• Evidence-Based Practice

Background:

• Early mobilization is increasingly recognized as a critical component of care for critically ill children.
• Defining and implementing early mobilization protocols in pediatric intensive care units (PICUs) presents unique challenges.

Purpose of the Study:

• To systematically review the literature for definitions of early mobilization in critically ill children.
• To describe the existing evidence regarding the safety and efficacy of early mobilization in this vulnerable population.

Main Methods:

• A systematic search of multiple databases (MEDLINE, Embase, CINAHL, CENTRAL, etc.) was conducted for relevant studies.
• Included were randomized and non-randomized studies, as well as clinical practice guidelines, focusing on children under 18 years.
• Data extraction focused on definitions, interventions, barriers, feasibility, adverse events, and efficacy outcomes.

Main Results:

• Eleven studies and one guideline were included, revealing diverse definitions for "early" mobilization (e.g., within 48-72 hours or based on clinical criteria).
• Current evidence indicates that early mobilization is safe and feasible in critically ill children.
• Institutional guidelines positively impact rehabilitation consult frequency and early mobilization rates.

Conclusions:

• The definition of early mobilization in critically ill children lacks standardization but is generally considered feasible and safe.
• The efficacy of early mobilization for improving outcomes in this population remains uncertain due to the low certainty and heterogeneity of the available evidence.