Prevalence of acute rehabilitation for kids in the PICU: A Canadian multicenter point prevalence study

Karen Choong, David J. Zorko, Ronke Awojoodu, Laurence Ducharme-Crevier, Patricia S. Fontela, Laurie A. Lee, Anne Marie Guerguerian, Gonzalo Garcia Guerra, Kristina Krmpotic, Brianna McKelvie, Kusum Menon, Srinivas Murthy, Anupam Sehgal, Matthew J. Weiss, Sapna R. Kudchadkar

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To evaluate mobilization practices, barriers, and mobility-related adverse events in Canadian PICUs. Design: National 2-day point prevalence study. Setting: Thirteen PICUs across Canada. Patients: Children with a minimum 72-hour PICU length of stay on the allocated study day. Interventions: None. Measurements and Main Results: Outcomes of interest were the prevalence and nature of mobilization activities, rehabilitation resources, adverse events, and factors associated with out-of-bed mobility and therapist-provided mobility. Two PICUs (15%) had early mobilization practice guidelines, and one PICU (8%) reported a formal process for engaging families in the mobilization of patients. The prevalence of mobilization was 110 of 137 patient-days (80%). The commonest activity was out-of-bed mobility (87/137; 64% patient-days); there was no active mobilization on 46 patient-days (34%). Therapists provided mobility on 33% of patient-days. Mobility was most commonly facilitated by nurses (74% events) and family (49% events). Family participation was strongly associated with out-of-bed mobility (odds ratio 6.4; p = 0.001). Intubated, mechanically ventilated patients were mobilized out-of-bed on 18 of 50 patient-days (36%). However, the presence of an endotracheal tube, vasoactive infusions, and age greater than or equal to 3 years were independently associated with not being mobilized out-of-bed. Barriers were reported on 58 of 137 patient-days (42%), and adverse events occurred in 22 of 387 mobility events (6%). Conclusions: Mobilization is common and safe, and the majority of children in Canadian PICUs are being mobilized out-of-bed, even when mechanically ventilated. Family engagement in PICU-based rehabilitation is increasing. This study provides encouraging evidence that common barriers can be overcome in order to safely mobilize children in PICUs.

Original languageEnglish (US)
Pages (from-to)181-193
Number of pages13
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - 2021

Keywords

  • critical care
  • intensive care units
  • occupational therapy
  • pediatrics
  • physical therapy
  • rehabilitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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