Early mobilisation in critically ill children: Does routine patient screening reduce time to commencing mobilisation?

Catherine E M Simpson; Adrian J Esterman; Subodh S Ganu; Kazuhiro Maki; Steve R Keeley; Emily J Ward; Margarita D Tsiros

doi:10.1016/j.aucc.2021.12.007

Early mobilisation in critically ill children: Does routine patient screening reduce time to commencing mobilisation?

Aust Crit Care. 2023 Mar;36(2):208-214. doi: 10.1016/j.aucc.2021.12.007. Epub 2022 Feb 5.

Authors

Catherine E M Simpson¹, Adrian J Esterman², Subodh S Ganu³, Kazuhiro Maki⁴, Steve R Keeley⁴, Emily J Ward⁵, Margarita D Tsiros⁶

Affiliations

¹ Allied Health Department, Women's and Children's Health Network, Australia; University of South Australia, Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, Australia. Electronic address: Catherine.Simpson@mymail.unisa.edu.au.
² University of South Australia, Clinical and Health Sciences, Australia.
³ Department of Paediatric Critical Care Medicine, Women's and Children's Health Network, Australia; University of Adelaide, Adelaide, Australia.
⁴ Department of Paediatric Critical Care Medicine, Women's and Children's Health Network, Australia.
⁵ University of South Australia, Allied Health and Human Performance, Australia.
⁶ University of South Australia, Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, Australia; University of South Australia, UniSA Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health (IIMPACT), Australia.

PMID: 35135715
DOI: 10.1016/j.aucc.2021.12.007

Abstract

Objective: The objective of this study was to investigate the impact of daily screening for medical readiness to participate in early mobilisation in the paediatric intensive care unit (PICU), on reducing time to mobilisation and to explore the safety-, feasibility-, and patient-level barriers to the practice.

Methods: An interventional study with a historical control group was conducted in a PICU in a tertiary teaching hospital in Australia. The Early Mobilisation Screening Checklist was applied at 24-48 h of PICU stay with the aim to reduce time to commencing mobilisation. All patients aged term to 18 years admitted to the PICU for >48 h were included in this study. Data on time to mobilisation and patient characteristics were collected by an unblinded case note audit of children admitted to the PICU over 5 months in 2018 for the baseline group and over a corresponding period in 2019 for the intervention group.

Measurements and main results: A total of 71 children were enrolled. Survival analysis was used to compare time to mobilisation between groups, and a cox regression model found that children in the intervention group were 1.26 times more likely to participate in mobility, but this was not statistically significant (P = 0.391, log rank test for equality of survival functions). Early mobilisation was safe, with no adverse events reported in 177 participant mobilisation days. Feasibility was demonstrated by 62% of participants mobilising within 72 h of admission. Mechanical ventilation during stay (P = 0.043) and days receiving sedation infusion (% of days) (P = 0.042) were associated with a decreased likelihood of participating in mobility.

Conclusions: Implementation of routine screening alone does not significantly reduce time to commencing mobility in the PICU. Early mobilisation in the PICU is safe and feasible and resulted in no adverse events during mobilisation. Patient characteristics influencing participation in mobility warrant further exploration.

Keywords: Children; Critical care; Early mobilisation; Intensive care units; Physiotherapy; Rehabilitation.

Publication types

Controlled Clinical Trial

MeSH terms

Aged
Child
Critical Illness*
Early Ambulation* / methods
Humans
Intensive Care Units, Pediatric
Physical Therapy Modalities
Respiration, Artificial