TY - JOUR
T1 - Prevalence of acute rehabilitation for kids in the PICU
T2 - A Canadian multicenter point prevalence study
AU - Choong, Karen
AU - Zorko, David J.
AU - Awojoodu, Ronke
AU - Ducharme-Crevier, Laurence
AU - Fontela, Patricia S.
AU - Lee, Laurie A.
AU - Guerguerian, Anne Marie
AU - Garcia Guerra, Gonzalo
AU - Krmpotic, Kristina
AU - McKelvie, Brianna
AU - Menon, Kusum
AU - Murthy, Srinivas
AU - Sehgal, Anupam
AU - Weiss, Matthew J.
AU - Kudchadkar, Sapna R.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - critical care
KW - intensive care units
KW - occupational therapy
KW - pediatrics
KW - physical therapy
KW - rehabilitation
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U2 - 10.1097/PCC.0000000000002601
DO - 10.1097/PCC.0000000000002601
M3 - Article
C2 - 33116069
AN - SCOPUS:85102090856
SP - 181
EP - 193
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
ER -