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Published on: June 14, 2024
Benefits of Early Mobilization After Pediatric Liver Transplantation
Norihiko Tsuboi1, Miku Hiratsuka1, Setsushi Kaneko1
1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Early mobilization significantly improved physical therapy access and outcomes for pediatric liver transplant patients in the PICU. This intervention shortened recovery time and hospital stays for children who could walk prior to surgery.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Rehabilitation medicine
Background:
- Pediatric liver transplantation requires intensive post-operative care in the Pediatric Intensive Care Unit (PICU).
- Early mobilization is crucial for recovery but often challenging in critically ill pediatric patients.
Purpose of the Study:
- To evaluate the impact of an early mobilization intervention on pediatric liver transplant recipients in the PICU.
- To assess changes in physical therapy utilization and patient recovery metrics.
Main Methods:
- A retrospective before-and-after study design was employed over 70 months.
- An early mobilization intervention was implemented, focusing on a multidisciplinary team approach in a 20-bed tertiary PICU.
- Seventy-five pediatric patients (2-18 years) who could walk pre-transplant were included.
Main Results:
- Significant increases in physical therapy provision in the PICU, particularly within 48 hours post-transplant (66% vs 100%, p < 0.001).
- Increased physical therapy time per patient and per PICU day.
- Patients in the post-mobilization group regained ambulation ability sooner (23 vs 28 days, p=0.015) and had shorter hospital stays (40 vs 55 days, p=0.012).
Conclusions:
- Implementation of early mobilization significantly enhanced physical therapy delivery for pediatric liver transplant patients.
- Early mobilization is a beneficial intervention, leading to faster recovery of walking ability and reduced hospital length of stay.
Objective:
To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU.
Design:
A 70-month retrospective before-after study.
Setting:
Medical and surgical PICU with 20 beds at a tertiary children's hospital.
Patients:
Seventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery.
Intervention:
We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach.
Measurements And Main Results:
There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0-10.6 min] vs 17.4 min [13.2-26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16-66] vs 23 [19-31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37-99] vs 40 [31-54] postoperative days; p = 0.012).
Conclusions:
Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.
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