Evaluation of an Early Mobilization Program in a Pediatric Intensive Care Unit

Abstract

Introduction: The focus of care in a pediatric intensive care unit (PICU) is on resuscitation, stabilization, management of critical disease processes, and reversal of organ failure. As a result, the child is often sedated, restrained and confined to bed for prolonged periods of time for perceived needs of safety, comfort and hemodynamic stability. Multi-system anatomic and physiologic alterations are known to occur in response to critical illness and may be compounded by immobility. These sequelae may have long- term implications for the patient and the patient’s family. A robust body of literature has showed that early mobilization in the intensive care unit can decrease these sequelae and reduce length of stay for the critically ill adult, but little has been published in regards to the pediatric population. Objective: To determine the safety and feasibility of an early rehabilitation and progressive mobilization program in a pediatric intensive care unit. Method: A before/after retrospective design was used for this QI project that focused on evaluating an early mobility program as it became routine care for the children hospitalized in this PICU. Data was collected and analyzed from July to August 2014 (pre-implementation phase) and July to August 2015 (post-implementation). Program implementation was completed in April to May 2015. Setting: Pediatric intensive care unit (PICU) in a tertiary academic hospital in the US. Results: Analysis of 200 children aged 1 day through 17 years admitted to a Pediatric Intensive Care Unit with a length of stay of at least three days demonstrated a significant increase in occupational and physical therapy consultations after implementation of the early mobility program (p <0.05) . In addition the number of mobilization activities increased post-implementation (p <0.05). No adverse events, such as unplanned extubations, occurred as a result of early mobilization. Conclusions: Implementation of a structured and stratified early mobilization program in a pediatric intensive care unit resulted in an increase in occupational and physical therapy consultations, increased patient activity, without adverse events.