TY - JOUR
T1 - Mobilization practices in critically ill children
T2 - A European point prevalence study (EU PARK-PICU)
AU - Ista, Erwin
AU - Scholefield, Barnaby R.
AU - Manning, Joseph C.
AU - Harth, Irene
AU - Gawronski, Orsola
AU - Bartkowska-Śniatkowska, Alicja
AU - Ramelet, Anne Sylvie
AU - Kudchadkar, Sapna R.
AU - EU PARK-PICU
A2 - Ritson, Paul C.
A2 - Nikolaou, Filippia
A2 - De Neef, Marjorie
A2 - Kneyber, Martin
A2 - Penny-Thomas, Kate
A2 - Linton, Christina
A2 - Balmaks, Reinis
A2 - Richter, Matthias
A2 - Chiusolo, Fabrizio
A2 - Cecchetti, Corrado
A2 - Roberti, Marco
A2 - Di Furia, Michela
A2 - Grandjean, Chantal
A2 - Nygaard, Bettina
A2 - Lopez, Yolanda
A2 - Koroglu, Tolga
A2 - Besci, Tolga
A2 - Mora, Roberta Da Rin Della
A2 - Agbeko, Rachel S.
A2 - Borrows, Emma
A2 - Bochaton, Nathalie
A2 - Mattsson, Janet
A2 - Ksellmann, Anne
A2 - Hero, Barbara
A2 - Rosada-Kurasinska, Jowita
A2 - Świder, Magdalena
A2 - Bonaldi, Amabile
A2 - Giugni, Cristina
A2 - Oruganti, Siva
A2 - Gates, Simon
A2 - Smith, Hazel
A2 - Van Zwol, Annelies
A2 - Hills, Jenna
A2 - Conroy, Johanna
A2 - Bebbington, Mark
A2 - Neunhoeffer, Felix
A2 - Duval, Els
N1 - Publisher Copyright:
© 2020 The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6/24
Y1 - 2020/6/24
N2 - 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.
AB - 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.
KW - Critical care
KW - Developmental paediatrics
KW - Intensive care units
KW - Occupational therapy
KW - Paediatrics
KW - Physical therapy
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85086917859&partnerID=8YFLogxK
U2 - 10.1186/s13054-020-02988-2
DO - 10.1186/s13054-020-02988-2
M3 - Article
C2 - 32576273
AN - SCOPUS:85086917859
SN - 1364-8535
VL - 24
SP - 368
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 368
ER -