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

Research output: Contribution to journalArticlepeer-review

Authors

  • EU PARK-PICU Collaborators

Colleges, School and Institutes

External organisations

  • Erasmus Medical Center - Sophia Children's Hospital
  • Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
  • Institute for Inflammation and Ageing
  • Birmingham Women and Children's Hospital NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Walter-Brendel-Center of Experimental Medicine, Ludwig-Maximilians Universität Munich, Munich, Germany Munich Heart Alliance, Munich, Germany German Center for Cardiovascular Research, Munich, Germany.
  • Daiichi-Sankyo Italy, Rome, Italy.
  • Poznań University of Medical Sciences
  • Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
  • The Johns Hopkins University School of Medicine

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: [Figure not available: see fulltext.]

Details

Original languageEnglish
Article number368
Pages (from-to)368
JournalCritical care (London, England)
Volume24
Issue number1
Publication statusPublished - 24 Jun 2020

Keywords

  • Critical care, Developmental paediatrics, Intensive care units, Occupational therapy, Paediatrics, Physical therapy, Rehabilitation