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Published on: April 7, 2023
Mobilization Safety of Critically Ill Children
Jessica M LaRosa1, Archana Nelliot2, Munfarid Zaidi2
1Departments of Anesthesiology and Critical Care Medicine.
Insights
Early mobilization in pediatric intensive care units (PICUs) is safe for children, with few adverse events. Delirium increases safety risks, highlighting the need for improved provider confidence in pediatric critical care mobility.
Area of Science:
- Pediatric critical care medicine
- Patient safety
- Rehabilitation therapy
Background:
- Pediatric intensive care unit (PICU) patients suffer from immobility complications.
- Staff safety concerns hinder early mobilization for critically ill children.
- Early mobilization is crucial for pediatric recovery but faces safety barriers.
Purpose of the Study:
- To evaluate the safety of early mobilization in pediatric intensive care unit (PICU) patients.
- To identify factors influencing safety events during pediatric critical care mobilization.
Main Methods:
- Secondary analysis of a 2-day study involving 82 PICUs across 65 US hospitals.
- Included patients with >=72-hour admissions participating in mobility events.
- Primary outcome: incidence of potential safety events during mobilization.
Main Results:
- 4658 mobility events occurred across 1433 patient days, with a 4% potential safety event rate.
- Most events were transient physiologic changes; equipment dislodgement (0.3%), falls, and cardiac arrests were rare.
- Higher event rates were observed in patients with delirium (7.8%) or those not screened for delirium (4.7%).
Conclusions:
- Early mobilization in PICUs demonstrates a favorable safety profile.
- Delirium is a significant risk factor for safety events during pediatric critical care mobilization.
- Findings support enhanced provider education to increase confidence in mobilizing critically ill children.
Background:
Children in PICUs experience negative sequelae of immobility; however, interprofessional staff concerns about safety are a barrier to early mobilization. Our objective was to determine the safety profile of early mobilization in PICU patients.
Methods:
We conducted a secondary analysis of a 2-day study focused on physical rehabilitation in 82 PICUs in 65 US hospitals. Patients who had ≥72-hour admissions and participated in a mobility event were included. The primary outcome was occurrence of a potential safety event during mobilizations.
Results:
On 1433 patient days, 4658 mobility events occurred with a potential safety event rate of 4% (95% confidence interval [CI], 3.6%-4.7%). Most potential safety events were transient physiologic changes. Medical equipment dislodgement was rare (0.3%), with no falls or cardiac arrests. Potential safety event rates did not differ by patient age or sex. Patients had higher potential safety event rates if they screened positive for delirium (7.8%; adjusted odds ratio, 5.86; 95% CI, 2.17-15.86) or were not screened for delirium (4.7%; adjusted odds ratio, 3.98; 95% CI, 1.82-8.72). There were no differences in potential safety event rates by PICU intervention, including respiratory support or vasoactive support.
Conclusions:
Early PICU mobilization has a strong safety profile and medical equipment dislodgement is rare. No PICU interventions were associated with increased potential safety event rates. Delirium is associated with higher potential safety event rates. These findings highlight the need to improve provider education and confidence in mobilizing critically ill children.
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