Practice Recommendations for Early Mobilization in Critically Ill Children

Abstract

Prolonged immobility is associated with significant short- and long-term morbidities in critically ill adults and children. The majority of critically ill children remain immobilized while in the pediatric intensive care unit (PICU) due to limited awareness of associated morbidities, lack of comfort and knowledge on how to mobilize critically ill children, and the lack of pediatric-specific practice guidelines. The objective of this article was to develop consensus practice recommendations for safe, early mobilization (EM) in critically ill children. A group of 10 multidisciplinary experts with clinical and methodological expertise in physical rehabilitation, EM, and pediatric critical care collaborated to develop these recommendations. First, a systematic review was conducted to evaluate existing evidence on EM in children. Using an iterative process, the working document was circulated electronically to panel members until the group reached consensus. The group agreed that the overall goals of mobilization are to reduce PICU morbidities and optimize recovery. EM should therefore not be instituted in isolation but as part of a rehabilitation care bundle. Mobilization should not be delayed, but its appropriateness and safety should be assessed early. Increasing levels of physical activity should be individualized for each patient with the goal of achieving the highest level of functional mobility that is developmentally appropriate, for increasing durations, daily. We developed a system-based set of clinical safety criteria and a checklist to ensure the safety of mobilization in critically ill children. Although there is a paucity of pediatric evidence on the efficacy of EM, there is ample evidence that prolonged bed rest is harmful and should be avoided. These EM practice recommendations were developed to educate clinicians, encourage safe practices, reduce PICU-acquired morbidities, until future pediatric research provides evidence on effective rehabilitation interventions and how best to implement these in critically ill children.

Hospital Physical Therapy Management in Pediatric Patients With Covid-19: Case Reports

“…16 Besides that, the exercises considered the patient's previous functional condition, with progressively increasing intensity and frequency, according to the patient's clinical condition and tolerance. 17 The breathing techniques used followed the guidelines, 18 age, and patient collaboration. Although most cases of COVID-19 evolve with a dry cough, 19 in both cases described there was impairment of bronchial hygiene, and techniques were applied for this purpose.…”

Feasibility and Safety of Early Mobilization in Critically Ill Children: A Prospective Observational Study

“…The aim of this study was to consider feasibility and safety of early mobilization for children from 0 to 2 years at PICU. Practice recommendations for early mobilization in critically ill children are poorly described [15,16].…”

Protocolo de mobilização precoce de paciente crítico e reabilitação pós-alta hospitalar na população infantil acometida de COVID-19

“…Essa condição agrava a morbidade e aumenta a mortalidade. Portanto, recomenda-se a utilização de protocolo de mobilização precoce para que seja evitada/minimizada a FMA-UTI [10][11][12] (Quadro 1). Há critérios a serem seguidos, inicia-se com movimentos passivos e, progressivamente, na presença do despertar diário , somam-se movimentos ativo assistidos de acordo com o DNPM 13,11 (Tabela 1).…”