Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

Author:

Ista ErwinORCID,Scholefield Barnaby R.,Manning Joseph C.,Harth Irene,Gawronski Orsola,Bartkowska-Śniatkowska Alicja,Ramelet Anne-Sylvie,Kudchadkar Sapna R.,Ritson Paul C.,Nikolaou Filippia,de Neef Marjorie,Kneyber Martin,Penny-Thomas Kate,Linton Christina,Balmaks Reinis,Richter Matthias,Chiusolo Fabrizio,Cecchetti Corrado,Roberti Marco,Di Furia Michela,Grandjean Chantal,Nygaard Bettina,Lopez Yolanda,Koroglu Tolga,Besci Tolga,Mora Roberta Da Rin Della,Agbeko Rachel S.,Borrows Emma,Bochaton Nathalie,Mattsson Janet,Ksellmann Anne,Hero Barbara,Rosada-Kurasinska Jowita,Świder Magdalena,Bonaldi Amabile,Giugni Cristina,Oruganti Siva,Gates Simon,Smith Hazel,van Zwol Annelies,Hills Jenna,Conroy Johanna,Bebbington Mark,Neunhoeffer Felix,Duval Els,

Abstract

Abstract Background Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. Methods A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Results Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7–43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09–19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12–0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Conclusion Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children. Graphical abstract

Publisher

Springer Science and Business Media LLC

Subject

Critical Care and Intensive Care Medicine

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