Mobilization practices in critically ill children: A European point prevalence study (EU PARK-PICU)

Erwin Ista, Erwin Ista, Barnaby R. Scholefield, Barnaby R. Scholefield, Joseph C. Manning, Joseph C. Manning, Irene Harth, Orsola Gawronski, Alicja Bartkowska-Śniatkowska, Anne Sylvie Ramelet, Sapna R. Kudchadkar, Sapna R. Kudchadkar, Sapna R. Kudchadkar, Paul C. Ritson, Filippia Nikolaou, Marjorie De Neef, Martin Kneyber, Kate Penny-Thomas, Christina Linton, Reinis BalmaksMatthias Richter, Fabrizio Chiusolo, Corrado Cecchetti, Marco Roberti, Michela Di Furia, Chantal Grandjean, Bettina Nygaard, Yolanda Lopez, Tolga Koroglu, Tolga Besci, Roberta Da Rin Della Mora, Rachel S. Agbeko, Emma Borrows, Nathalie Bochaton, Janet Mattsson, Anne Ksellmann, Barbara Hero, Jowita Rosada-Kurasinska, Magdalena Świder, Amabile Bonaldi, Cristina Giugni, Siva Oruganti, Simon Gates, Hazel Smith, Annelies Van Zwol, Jenna Hills, Johanna Conroy, Mark Bebbington, Felix Neunhoeffer, Els Duval

Research output: Contribution to journalArticlepeer-review

Abstract

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. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
Article number368
JournalCritical Care
Volume24
Issue number1
DOIs
StatePublished - Jun 24 2020

Keywords

  • Critical care
  • Developmental paediatrics
  • Intensive care units
  • Occupational therapy
  • Paediatrics
  • Physical therapy
  • Rehabilitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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