Nurse-driven early rehabilitation protocol for critically ill children

Area of Science:

• Pediatric critical care medicine
• Rehabilitation therapy
• Nursing science

Background:

• Physical impairment is a significant cause of morbidity in children who survive intensive care.
• Early mobilization is crucial for recovery and reducing long-term complications in pediatric patients.

Purpose of the Study:

• To evaluate the effectiveness of a nurse-driven protocol for early mobilization in critically ill children.
• To assess the protocol's impact on motor dysfunction, pediatric intensive care unit (PICU) length of stay, and ventilator days.
• To determine the safety of the early mobilization protocol, monitoring for injuries and cardiorespiratory instability.

Main Methods:

• A retrospective interrupted time-series study design comparing pre-implementation (Jan-June 2020) and post-implementation (July-Dec 2020) phases.
• Utilized the Functional Status Scale's motor function domain to assess motor dysfunction post-PICU discharge.
• Compared outcomes between a control group and a group receiving the nurse-driven early mobilization protocol.

Main Results:

• A statistically significant reduction in motor dysfunction was observed post-protocol implementation (64.0% vs 36.0%, P = 0.044), with an absolute risk reduction of 28%.
• The number needed to treat was 3.6 children to prevent one instance of motor dysfunction.
• No significant differences were found in median ventilator days, PICU length of stay, or hospital length of stay. No complications were reported.

Conclusions:

• A nurse-driven protocol for early mobilization is feasible in the pediatric intensive care unit setting.
• This protocol can be effective in reducing motor dysfunction in critically ill children following intensive care.
• The intervention demonstrated a favorable safety profile without adverse events.