In-Bed Mobilization in Critically Ill Children: A Safety and Feasibility Trial
Karen Choong1,2,3, Maria D P Chacon1, Rachel G Walker4
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
In-bed cycling is a safe and feasible method to increase physical activity in critically ill children. Interactive video games showed limited feasibility for active mobilization in this patient group.
Area of Science:
- Pediatric Critical Care
- Rehabilitation Medicine
- Clinical Feasibility Studies
Background:
- Critically ill children in the Pediatric Critical Care Unit (PCCU) often experience immobility, leading to deconditioning.
- Implementing early mobilization strategies is crucial for improving outcomes in this vulnerable population.
- Feasibility and safety of novel in-bed mobilization techniques require thorough evaluation.
Purpose of the Study:
- To assess the feasibility and safety of two in-bed mobilization methods in critically ill children.
- To evaluate the impact of these interventions on physical activity levels.
- To identify potential barriers and facilitators for implementing in-bed mobilization.
Main Methods:
- Prospective cohort trial at a Pediatric Critical Care Unit (PCCU).
- Inclusion of hemodynamically stable patients aged 3-17 years with expected PCCU stay >24 hours.
- Interventions included passive in-bed cycling and active video games (VG), applied for up to 2 days.
Main Results:
- 31 of 406 screened patients participated; 25 received interventions.
- In-bed cycling was utilized by 21 patients, VG by 5. 15 patients completed the 2-day intervention.
- In-bed cycling increased physical activity; no adverse events were reported. VG feasibility was limited to cooperative, age-appropriate patients.
Conclusions:
- In-bed cycling is a safe and feasible option for enhancing physical activity in critically ill children.
- Video games show potential for active mobilization but require further investigation for broader applicability.
- Further research is needed to establish the efficacy of these methods for rehabilitation in pediatric critical care.
Abstract:
The objective of this study was to evaluate the feasibility and safety of implementing two methods of in-bed mobilization in critically ill children. This prospective cohort trial was conducted at McMaster Children's Hospital, Pediatric Critical Care Unit (PCCU). Hemodynamically stable patients aged 3 to 17 years with a longer than 24-hour PCCU stay were eligible to participate in the study. Children with cardiorespiratory instability, already mobilizing well or at their baseline mobility, anticipated death during this PCCU admission, and those with contraindications to mobilization were excluded. Two methods of mobilization were applied for a maximum of 2 days, respectively, depending on the level of consciousness and cognitive ability of the participant. In-bed cycling was used for passive mobilization and interactive video games (VG) were used for active mobilization. The primary outcomes were safety and feasibility. Secondary outcomes were physical activity during the study period, as reflected by accelerometer measurements. A total of 406 patients were screened over 1 year, 35 of who were eligible and 31 (89%) consented to participate. Median age of participants was 11 years (quartile 1 is 6 years and quartile 3 is 14 years), and 15 (48%) were male. Twenty-five (81%) participants received the study intervention, 22 (88%) of who received the intervention within 24 hours of consent. Twenty-one (84%) participants received in-bed cycling, five (20%) received VG, and only one received both. Fifteen (60%) completed the prescribed 2-day intervention, while in 11 (44%) the intervention was interrupted or not applied, most commonly because the patient was transferred out of the PCCU. Physical activity was greater during the intervention compared with nonintervention times with in-bed cycling, but not with VG. There were no adverse events attributable to the intervention. This pilot reveals that in-bed cycling can enhance physical activity, and appears to be safe and feasible in this group of critically ill children. VG was feasible only in a minority of patients who were cooperative and age appropriate. Further research is necessary to evaluate the efficacy and most appropriate methods of enhancing mobility and rehabilitation in this population.
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