Early mobilisation and rehabilitation in the PICU: a UK survey

Abstract

ObjectiveTo understand the context and professional perspectives of delivering early rehabilitation and mobilisation (ERM) within UK paediatric intensive care units (PICUs).DesignA web-based survey administered from May 2019 to August 2019.SettingUK PICUs.ParticipantsA total of 124 staff from 26 PICUs participated, including 22 (18%) doctors, 34 (27%) nurses, 28 (23%) physiotherapists, 19 (15%) occupational therapists and 21 (17%) were other professionals.ResultsKey components of participants’ definitions of ERM included tailored, multidisciplinary rehabilitation packages focused on promoting recovery. Multidisciplinary involvement in initiating ERM was commonly reported. Over half of respondents favoured delivering ERM after achieving physiological stability (n=69, 56%). All age groups were considered for ERM by relevant health professionals. However, responses differed concerning the timing of initiation. Interventions considered for ERM were more likely to be delivered to patients when PICU length of stay exceeded 28 days and among patients with acquired brain injury or severe developmental delay. The most commonly identified barriers were physiological instability (81%), limited staffing (79%), sedation requirement (73%), insufficient resources and equipment (69%), lack of recognition of patient readiness (67%), patient suitability (63%), inadequate training (61%) and inadequate funding (60%). Respondents ranked reduction in PICU length of stay (74%) and improvement in psychological outcomes (73%) as the most important benefits of ERM.ConclusionERM is gaining familiarity and endorsement in UK PICUs, but significant barriers to implementation due to limited resources and variation in content and delivery of ERM persist. A standardised protocol that sets out defined ERM interventions, along with implementation support to tackle modifiable barriers, is required to ensure the delivery of high-quality ERM.

Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units

“…The questionnaire results show that the respondents have a positive viewpoint on early mobilisation and believe that early mobilisation can improve critically ill children's outcomes. These results are consistent with the results from earlier studies 9,17,21,26 . In our study and earlier studies, the most important barriers to early mobilisation are patient‐related factors: hemodynamic instability, the risk of dislocation of endotracheal tubes and vascular catheters and the level of sedation of the patient.…”

“…Yet, this was not ranked as an important barrier, whereas patient‐related factors were perceived as more important barriers. This contrasts with earlier studies that reported that PICU staff considered the lack of equipment, increased workload and the lack of practice guidelines to be significant barriers to early mobilisation 18,26,28,29 …”

“…These results are consistent with the results from earlier studies. 9,17,21,26 In our study and earlier studies, the most important barriers to early mobilisation are patient-related factors: hemodynamic instability, the risk of dislocation of endotracheal tubes and vascular catheters and the level of sedation of the patient. It has been shown that early mobilisation of critically ill children is safe and feasible when these patient-related barriers are accounted for in guidelines that clearly state the way in which certain children preferably should be mobilised.…”

“…This contrasts with earlier studies that reported that PICU staff considered the lack of equipment, increased workload and the lack of practice guidelines to be significant barriers to early mobilisation. 18,26,28,29 6.1 | Application to practice…”

Rehabilitation across the life course and critical care pathway: Much more than learning to walk again

“…Exercise principles can be exploited from the Physical Activity Guidelines for Americans 11 but beyond that, acute interventions are founded on clinical reasoning rather than the evidence base. The lack of a standardized protocol, inclusive of safe and defined activities, in paediatrics was seen as a barrier to rehabilitation delivery 12 . While protocols may support the delivery of early rehabilitation, flexibility and the independence to create individualized interventions are essential.…”