Practice Recommendations for Early Mobilization in Critically Ill Children.

Area of Science:

• Pediatric Critical Care Medicine
• Rehabilitation Therapy
• Clinical Practice Guidelines

Background:

• Prolonged immobility in critically ill children leads to significant short- and long-term morbidities.
• Limited awareness, lack of expertise, and absence of pediatric-specific guidelines contribute to widespread immobility in the pediatric intensive care unit (PICU).

Purpose of the Study:

• To develop consensus-based practice recommendations for safe and early mobilization (EM) of critically ill children.
• To address the need for standardized approaches to reduce PICU-acquired morbidities and improve patient recovery.

Main Methods:

• A systematic review of existing evidence on EM in pediatric populations was conducted.
• A multidisciplinary expert panel (10 members) collaborated using an iterative consensus-building process.
• Development of system-based clinical safety criteria and a mobilization checklist.

Main Results:

• Consensus was reached on the goals of mobilization: reducing PICU morbidities and optimizing recovery.
• EM should be integrated into a rehabilitation care bundle, assessed early for safety and appropriateness.
• Individualized, progressive physical activity is recommended to achieve developmentally appropriate functional mobility.

Conclusions:

• Despite a paucity of pediatric-specific efficacy data, prolonged bed rest is demonstrably harmful and should be avoided.
• These recommendations aim to educate clinicians, promote safe mobilization practices, and reduce morbidities in critically ill children.
• Further research is needed to establish evidence-based rehabilitation interventions for this population.