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Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)
Erwin Ista1,2, Barnaby R Scholefield3,4, Joseph C Manning5,6
1Pediatric Intensive Care Unit, Department of Paediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. w.ista@erasmusmc.nl.
Insights
Physical rehabilitation is underutilized in European pediatric intensive care units (PICUs). Family presence aids mobilization, while mechanical ventilation hinders it, indicating a need for interdisciplinary approaches.
Area of Science:
- Pediatric Intensive Care
- Rehabilitation Medicine
- Multicenter European Study
Background:
- Early mobilization in adult intensive care improves outcomes.
- Mobilization practices in pediatric intensive care units (PICUs) are not well understood.
- This study investigated physical rehabilitation in European PICUs.
Purpose of the Study:
- Determine the prevalence of physical rehabilitation in European PICUs.
- Identify factors associated with mobilization in critically ill children.
- Highlight barriers and safety events related to pediatric mobilization.
Main Methods:
- Cross-sectional, multicenter point prevalence study in 38 PICUs across 15 European countries.
- Data collected over 2 days in May and November 2018.
- Included clinical data, mobility, safety events, and barriers for patients admitted ≥72 hours.
Main Results:
- Prevalence of physical therapy (PT) or occupational therapy (OT) mobility activities was 39%.
- Family presence strongly associated with out-of-bed mobilization (aOR 7.83); invasive mechanical ventilation associated with less mobility (aOR 0.28).
- 25% of patient days involved complete immobility; 38% reported mobilization barriers, including cardiovascular instability and oversedation. 6% of mobilizations had safety events.
Conclusions:
- Therapist involvement in mobilizing critically ill children in European PICUs is infrequent.
- A systematic, interdisciplinary approach to mobilization is needed for critically ill children.
- Addressing barriers and leveraging facilitators like family presence can improve pediatric intensive care mobility.
Background:
Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe.
Methods:
A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h.
Results:
Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events.
Conclusion:
Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.
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