Early Mobilization of Critically Ill Kids Appears Safe

By Brandon May

April 06, 2022

NEW YORK (Reuters Health) - Early mobilization of critically ill kids, which can help prevent the sequelae of immobility during stays in pediatric intensive-care units (PICUs), appears to be safe, a new study suggests.

"Critically ill children are at high risk of weakness and decreased quality of life as a result of prolonged bed rest," said Dr. Jessica LaRosa of Johns Hopkins University School of Medicine, in Baltimore, Maryland.

In a paper in Pediatrics, she and her colleagues note that critically ill children in the PICU face increased risks of physical, cognitive and psychological impairment that can impact their health-related quality of life long after discharge.

Although early mobilization and rehabilitation in the ICU "is a proven strategy to optimize outcomes for adults and kids," Dr. LaRosa told Reuters Health by email, many critically ill children are not mobilized because clinicians are concerned about possible safety events.

"Our goal is to eliminate the barriers surrounding mobility for critically ill children so that they have the best short- and long-term outcomes possible," Dr. LaRosa said.

To assess the safety of early mobilization, Dr. LaRosa and her colleagues did a secondary analysis of a two-day study that looked at 1,769 patients at 82 PICUs in the U.S. The researchers focused on patients who were admitted for 72 hours or more and participated in a mobility event, which was defined as a discrete physical activity provided by either a family member or provider.

A total of 4,658 mobility occurred during 1,433 patient days, with a rate of potential safety events of 4%. Many of these events were transient physiologic changes, which is similar to what's seen in adults, the researchers say.

The rate of medical-equipment dislodgement was 0.3%, and there were no reported falls or cardiac arrests.

Higher rates of potential safety events were observed in patients who screened positive for delirium (7.8%) or were not screened for delirium (4.7%) compared with those who screened negative (1.9%).

Dr. LaRosa said "the next critical step is to ensure that clinical staff are knowledgeable about the benefits of (early) mobility and how safe it is with good preparation and planning."

Dr. Kumaran Senthil of the Children's Hospital of Philadelphia said the study is important given that it addresses concerns over inadvertent harm caused by early mobilization.

"Understanding the risk and potential factors that can mitigate that risk in critically ill children is an important step towards better studying the long-term effects of early mobilization of these patients," Dr. Senthil, who wasn't involved in the research, told Reuters Health by email.

Dr. Senthil added that the findings support the use of multidisciplinary rehabilitation-support services for children in the PICU. "Once the barriers of education and comfort are addressed," he said, "these multidisciplinary teams can create an ICU culture that allows for seamless and integrated early mobilization in our critically ill children."

SOURCE: https://bit.ly/3qVtpyH Pediatrics, online March 30, 2022.