Early Mobilization in PICU: Are We on Time?
Tóm tắt
Elements based on specific literature to assist in the elaboration of an early mobilization (EM) protocol for severely ill children in a pediatric intensive care unit or in an inpatient care unit. Recent findings have shown that immobility during critical periods of the disease may cause physical, neuromusculoskeletal, metabolic, cognitive, and psychological sequelae that may extend throughout life. Prolonged bed rest is associated with thromboembolic events, decreased protein synthesis and muscle mass, and increased risk of death. Children surviving from serious illnesses have an increased risk of delay in overall recovery, resulting in poor quality of life and increased costs of post-discharge health services in the short, medium, and long term. Further research is needed to delineate protocols for specific populations in PICU as well as to find associations between interventions in PICU with EM, and with outcome times spent in PICU and hospital, need for care after hospital discharge, death and quality of life, among others.
Tài liệu tham khảo
Choong K, Foster G, Fraser DD, et al. Acute rehabilitation practices in critically ill children: a multicenter study. Pediatr Crit Care Med. 2014;15(6):270–9.
Goddard SL, Cuthbertson BH. Rehabilitation and critical illness. Anesth and Intens Care Med. 2012;13:214–6.
Williams S, Horrocks I, Ouvrier R, et al. Critical illness polyneuropathy and myopathy in pediatric intensive care: a review. Pediatr Crit Care Med. 2007;8:18–22.
Knoester H, Bronner MB, Bos AP. Surviving pediatric intensive care: physical outcome after 3 months. Intensive Care Med. 2008;34:1076–82.
• Ong C, Lee JH, Leow MK, et al. Functional outcomes and physical impairments in pediatric critical care survivors: a scoping review. Pediatr Crit Care Med. 2016;17(5):247–59 This important work approaches of functional outcome assessment tools, prevalence, and risk factors for physical disabilities in pediatric intensive care survivors.
Newacheck PW, Kim SE. A national profile of health care utilization and expenditures for children with special health care needs. Arch Pediatr Adolesc Med. 2005;159(1):10–7.
Moura EC, Moreira MCN, Menezes LA, et al. Complex chronic conditions in children and adolescents: hospitalizations in Brazil, 2013. Cien Saude Colet. 2017;22(8):2727–34.
Adler J, Malone D. EM in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012;23(1):5–13.
Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17(4):271–81.
Cameron S, Ball I, Cediminas C, et al. EM in the critical care unit: a review of adult and pediatric literature. J Crit Care. 2015;30:664–72.
•• Joyce CL, Taipe C, Sobin B, et al. Provider beliefs regarding EM in the pediatric intensive care unit. J Pediatr Nurs. 2018;38:15–9 This study demonstrates similar concerns between adult and pediatric programs, with the addition of significant concern surrounding EM in very young children.
Wieczorek B, Burke C, Al-Harbi A, et al. EM in the pediatric intensive care unit: a systematic review. 2015;129–170.
Choong K, Koo KKY, Clark H, et al. EM in critically ill children: a survey of Canadian practice. Crit Care Med. 2013;41:1745–53.
•• Wieczorek B, Ascenzi J, Kim Y, et al. PICU Up! Impact of a quality improvement intervention to promote EM in critically ill children. Pediatr Crit Care Med. 2016;17(12):e559–66 This important work helps to create a bundled intervention to create a healing environment in the PICU with structured activity that may have benefits for short- and long-term outcomes of critically ill children.
•• Colwell BRL, Williams CN, Kelly SP, et al. Mobilization therapy in the pediatric intensive care unit: a multidisciplinary quality improvement initiative. Am J Crit Care. 2018;27:194–203 This study shows multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit.
•• Zheng K, Sarti A, Boles S, et al. Impressions of early mobilization of critically ill children-clinician, patient, and family perspectives. Pediatr Crit Care Med. 2018;19(7):e350–7 This article evaluates the clinicians, patients, and families who were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice.
•• Choong K, Canci F, Clark H, et al. Practice recommendations for EM in critically ill children. J Pediatr Intensive Care. 2018;07:014–26 This practice recommendation helps to understand treatment priorities and rehabilitation strategies to improve functional recovery in critically ill children.
Hollander SA, Hollander AJ, Rizzuto S, et al. An inpatient rehabilitation program utilizing standardized care pathways after paracorporeal ventricular assist device placement in children. J Heart Lung Transplant. 2014;33(6):587–92.
Turner DA, Cheifetz IM, Rehder KJ, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med. 2011;39:2593–8.
• Parchem K, Peck A, Tales K. A multidisciplinary approach to equipment use in pediatric patient mobilization. Crit Care Nurs. 2018;41:330–9 This manuscript describes the specific equipment utilized during the different phases of mobility in pediatrics.
Walker TC, Kudchadkar SR. EM in the pediatric intensive care unit. Transl Pediatr. 2018;7(4):308–13.
Speyer E, Vuillemin A, Herbinet A, et al. Effect of adapted physical activity on health-related quality of life among hospitalized children and adolescents (the ACTIV’HOP randomized controlled trial): Design and methods. Contemp Clin Trials. 2010;31:165–71.
Abdulsatar F, Walker RG, Timmons BW, et al. Wii-Hab in critically ill children: a pilot trial. J Ped Rehabil Med: Interdiscip Approach. 2013;6:193–202.
Blumenstein MS. Early ambulation after acute deep vein thrombosis: is it safe? J Pediatr Oncol Nurs. 2007;24:309–13.
Choong K, Awladthani S, Khawaji A, et al. Early exercise in critically ill youth and children, a preliminary evaluation: the wEECYCLE Pilot Trial. Pediatr Crit Care Med. 2017;18(11):e546–54.
Cuello-Garcia CA, Mai SHC, Simpson R, et al. EM in critically ill children: a systematic review. J Pediatr. 2018;203:25–33.e6.
•• Van Damme D, Flori H, Owens T. Development of medical criteria for mobilizing a pediatric patient in the PICU. Crit Care Nur Q. 2018;41(3):323–9 This study aims to define clinical criteria for the safe indication of early mobilization in pediatrics.
•• Reid JC, Unger J, McCaskell D, et al. Physical rehabilitation interventions in the intensive care unit: a scoping review of 117studies. J Intensive Care. 2018;6:80 This important review identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation and future trial development.
Simone S, Edwards S, Lardieri A, et al. Implementation of an ICU bundle: an interprofessional quality improvement project to enhance delirium management and monitor delirium prevalence in a single PICU. Pediatr Crit Care Med. 2017;18(6):531–40.
Smith HA, Gangopadhyay M, Goben CM, et al. The preschool confusion assessment method for the ICU: valid and reliable delirium monitoring for critically ill infants and children. Crit Care Med. 2016;44(3):592–600.
Silver G, Kearney J, Traube C, et al. Delirium screening anchored in child development: the Cornell Assessment for Pediatric Delirium. Palliat Support Care. 2015;13(4):1005–11.
Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018;3:CD010754.
•• Ekim A. The post-intensive care syndrome in children. Compr Child Adolesc Nurs. 2018;25:1–7 This article approaches postintensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years.
Traube C, Silver G, Reeder RW, et al. Delirium in critically ill children: an international point prevalence study. Crit Care Med. 2017;45(4):584–90.