Early mobilisation in critically ill children: Does routine patient screening reduce time to commencing mobilisation?
Catherine E M Simpson1, Adrian J Esterman2, Subodh S Ganu3
1Allied Health Department, Women's and Children's Health Network, Australia; University of South Australia, Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, Australia.
Insights
Daily screening for early mobilisation in the paediatric intensive care unit (PICU) did not significantly reduce mobilisation time. However, early mobilisation proved safe and feasible, with no adverse events reported.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Rehabilitation Therapy
Background:
- Early mobilisation in the paediatric intensive care unit (PICU) is crucial for patient recovery.
- Barriers to implementing early mobilisation screening need to be understood.
Purpose of the Study:
- To assess the impact of daily screening for medical readiness on reducing time to early mobilisation in the PICU.
- To explore safety, feasibility, and patient-level barriers to early mobilisation practices.
Main Methods:
- An interventional study with a historical control group in a tertiary PICU.
- The Early Mobilisation Screening Checklist was applied 24-48 hours post-PICU admission.
- Data collected via case note audit for patients aged term to 18 years admitted for >48 hours.
Main Results:
- No statistically significant reduction in time to mobilisation was observed with daily screening (P=0.391).
- Early mobilisation was safe and feasible, with 62% mobilising within 72 hours and no adverse events.
- Mechanical ventilation and sedation infusion days were associated with decreased mobility participation.
Conclusions:
- Routine screening alone does not significantly expedite early mobilisation in the PICU.
- Early mobilisation in the PICU is safe and feasible.
- Patient factors influencing mobility participation require further investigation.
Objective:
The objective of this study was to investigate the impact of daily screening for medical readiness to participate in early mobilisation in the paediatric intensive care unit (PICU), on reducing time to mobilisation and to explore the safety-, feasibility-, and patient-level barriers to the practice.
Methods:
An interventional study with a historical control group was conducted in a PICU in a tertiary teaching hospital in Australia. The Early Mobilisation Screening Checklist was applied at 24-48 h of PICU stay with the aim to reduce time to commencing mobilisation. All patients aged term to 18 years admitted to the PICU for >48 h were included in this study. Data on time to mobilisation and patient characteristics were collected by an unblinded case note audit of children admitted to the PICU over 5 months in 2018 for the baseline group and over a corresponding period in 2019 for the intervention group.
Measurements And Main Results:
A total of 71 children were enrolled. Survival analysis was used to compare time to mobilisation between groups, and a cox regression model found that children in the intervention group were 1.26 times more likely to participate in mobility, but this was not statistically significant (P = 0.391, log rank test for equality of survival functions). Early mobilisation was safe, with no adverse events reported in 177 participant mobilisation days. Feasibility was demonstrated by 62% of participants mobilising within 72 h of admission. Mechanical ventilation during stay (P = 0.043) and days receiving sedation infusion (% of days) (P = 0.042) were associated with a decreased likelihood of participating in mobility.
Conclusions:
Implementation of routine screening alone does not significantly reduce time to commencing mobility in the PICU. Early mobilisation in the PICU is safe and feasible and resulted in no adverse events during mobilisation. Patient characteristics influencing participation in mobility warrant further exploration.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism