Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative

Jm, Herbsman; D'Agati, M; Klein, Deborah G.; O’Donnell, Sinéad; Corcoran, John; Td, Folks; Al-Qaqaa, Yasir

doi:10.1097/pq9.0000000000000256

Cited by 21 publications

(56 citation statements)

References 18 publications

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“…[2020] performed a "gap analysis" which highlighted the limited mobilization of patients in their PICU, as well as perceived and actual barriers to EM. As a result of this preliminary analysis, a targeted QI project was implemented aimed primarily at increasing the proportion of children receiving EM and secondarily to improving patient clinical outcomes (PICU length of stay and proportion discharged home) (73). Wieczorek et al [2016] implemented the "PICU UP!"…”

Section: Building a Picu Quality Culturementioning

confidence: 99%

“…[2020] mobilized family/patient-centered care team to improve a number of process measures related to EM, with interventions to increase rehabilitation referrals and activity orders; remove barriers to mobilization; educating and training multiple stakeholders on the benefits and methods to safely mobilize patients; develop an algorithm to identify patients appropriate for mobilization and ultimately change the culture of EM within the PICU (73). The interprofessional team of "champions" in the "PICU-Up!"…”

Section: Building a Picu Quality Culturementioning

confidence: 99%

“…[2020], for example, documented their primary QI outcome as the percentage of patients mobilized early, according to their stated definition, whilst process measures included the percentage of patients with therapy and activity orders as well as perceived barriers to EM. Secondary outcome measures included any adverse events, PICU and hospital length of stay and discharge disposition (73). The "PICU-Up!"…”

Section: Building a Picu Quality Culturementioning

confidence: 99%

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Building a culture of early mobilization in the pediatric intensive care unit—a nuts and bolts approach

Morrow¹

2021

Transl Pediatr

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The culture of sedation and immobilization in the pediatric intensive care unit (PICU) is associated with PICU-acquired weakness, delirium, and poor functional, neurocognitive and psychosocial outcomes. A structured approach to introducing physical activity, as early as possible after PICU admission, may prevent these complications and optimize the holistic outcomes of critically ill children. Changing culture and introducing new clinical practice in PICU is complex, but can be approached systematically, using a "nuts and bolts" approach targeting the basic, practical considerations and essential required elements or components. Extending the construction analogy, this article reviews the relevant literature to describe the essential elements required to build and sustain a successful and safe early mobility program in the PICU.Effective early mobilization requires individual patient assessment and goal setting, using a collaborative inter-disciplinary, patient-and family-centered approach, to ensure mobility goals and physical activities are appropriate for the patient's age, condition/s, premorbid function, strength, endurance and developmental level. Early mobility activities for the pediatric age spectrum include active or active-assisted range of motion exercises, neurodevelopmental play, use of mobility devices, in-bed exercises, transfers, sitting or standing tolerance, crawling, pre-gait activities, ambulation and activities of daily living, with a focus on play as function. Although there are few complete contraindications to early mobilization, appropriate precautions and preparation should be taken to mitigate potential safety concerns. Although there are many perceived barriers to early mobilization in the PICU, at the level of patient, provider, institution and knowledge translation; these are not objectively associated with increased risk during mobilization and can be overcome through an engaged process of practice change by all members of the interprofessional clinical team. Early mobility programs could be initiated in PICU as systematic quality improvement initiatives, with established processes to optimize structural, process and system elements and to provide continual feedback, measurement, benchmarking and collaboration; to ultimately impact on measurable patient outcomes. Early, graded, and individually prescribed mobilization should be considered as part of the standard PICU "package of care" for all critically ill and injured children, in order to improve their functional status and quality of life after PICU discharge.

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Section: Building a Picu Quality Culturementioning

confidence: 99%

Section: Building a Picu Quality Culturementioning

confidence: 99%

Section: Building a Picu Quality Culturementioning

confidence: 99%

See 1 more Smart Citation

Building a culture of early mobilization in the pediatric intensive care unit—a nuts and bolts approach

Morrow¹

2021

Transl Pediatr

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“…Ela está relacionada com atividades terapêuticas gradativas desde mudanças de decúbito até a deambulação, que deve ser executada respeitando os protocolos institucionais da UTI, minimizando complicações ao estado do paciente. (CONCEICAO et al, 2017;HERBSMAN et al, 2020;FEITOZA et al, 2014;SARTI, VECINA E FERREIRA, 2016AQUIM et al 2019FELICIANO et al, 2012 Diante das informações supracitadas sobre o contexto da mobilização precoce o presente estudo tem como objetivo de analisar a importância desta em pacientes na unidade de terapia intensiva.…”

Section: Considerações Finaisunclassified

“…de (SILVA, PACHECO 2017;. MACHADO et al 2016; ASOBRAFIR 2020;HERBSMAN et al 2020) Observamos que apesar do conhecimento acerca dos benefícios da mobilização precoce na UTI, ela não vem sido amplamente realizada nas unidades de terapia intensiva brasileiras.De acordo com Aquim (2019) e Fontela(2018) apenas 10% dos pacientes sob VM foram mobilizados precocemente, isso por conta de barreiras como: fraqueza muscular, nível de sedação e instabilidade cardiovascular, falta de tempo e recursos humanos para formação de uma equipe de profissionais dedicados a mobilização precoce, corroborando com a ASSOBRAFIR -2020, que afirma que para a implementação de protocolos para a mobilização precoce é necessário recursos humanos disponíveis, condições clinicas satisfatórias e equipamentos de proteção individual para a equipe de fisioterapia.No trabalho de Fontela(2018) foi observado, que a implementação de uma equipe dedicada na UTI demostrou uma diminuição de 2,5 dias das saídas dos pacientes do leito, além de resolver os custos hospitalares. Tendo em vista o respaldo da literatura deste sentido, as entidades de classe têm buscado através do projeto de lei PL1985/2019 a permanência obrigatória de fisioterapia em UTI no Brasil, no momento ocorre, geralmente está associada a assincronia entre o paciente e o VM.…”

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Processo De Envelhecimento E Atividade Física: Revisão Integrativa

Araújo¹

2021

Pesquisas Em Temas De Ciências Da Saúde

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Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point‐of‐Care Ultrasound in Critically Ill Children

Kim,

Wai,

Pedoeim

et al. 2024

J of Ultrasound Medicine

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ObjectivesSkeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)‐acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point‐of‐care ultrasound, a noninvasive and cost‐effective tool, we assess muscle decay through ultrasound of the quadriceps femoris.MethodsA prospective observational study was conducted in a single‐center quaternary‐care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay.ResultsAmong the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of −1.9% [IQR −0.8, −5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (−1.8 vs −2.4%, P < .001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r = .328, P = .007 and r = .393, P = .001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use.ConclusionThis study demonstrates early and frequent muscle decay in critically ill children, as detected by point‐of‐care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients.

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Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative

Cited by 21 publications

References 18 publications

Building a culture of early mobilization in the pediatric intensive care unit—a nuts and bolts approach

Building a culture of early mobilization in the pediatric intensive care unit—a nuts and bolts approach

Processo De Envelhecimento E Atividade Física: Revisão Integrativa

Assessing Clinical Variables Associated With Femoral Muscle Decay as Measured by Point‐of‐Care Ultrasound in Critically Ill Children

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