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

Ista, Erwin; Manning, Joseph; Scholefield, Barney; Harth, Irene; Gawronski, Orsola; Bartkowska-?niatkowska, Alicja; Ramelet, Anne-Sylvie; Kudchadkar, Sapna; EU PARK-PICU Collaborators

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 two-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 hours.

Results:
Data of 456 children admitted to one of 38 participating PICUs from 16 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% (115/341) 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 mobilisation approach for critically ill children.

Citation

Ista, E., Manning, J., Scholefield, B., Harth, I., Gawronski, O., Bartkowska-Śniatkowska, A., …EU PARK-PICU Collaborators. (2020). Mobilisation practices in critically ill children: A European point prevalence study (EU PARK-PICU). Critical Care, 24, Article 368. https://doi.org/10.1186/s13054-020-02988-2

• Journal Article Type: Article
• Acceptance Date: May 11, 2020
• Online Publication Date: Jun 24, 2020
• Publication Date: Jun 24, 2020
• Deposit Date: Aug 11, 2020
• Publicly Available Date: Aug 13, 2020
• Journal: Critical Care
• Print ISSN: 1574-4280
• Electronic ISSN: 1466-609X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Article Number: 368
• DOI: https://doi.org/10.1186/s13054-020-02988-2
• Public URL: https://nottingham-repository.worktribe.com/output/4417251
• Publisher URL: https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02988-2