Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)
Erwin Ista, Barnaby R. Scholefield, Joseph C. Manning, Irene Harth, Orsola Gawronski, Alicja Bartkowska‐Śniatkowska, Anne‐Sylvie Ramelet, Sapna R. Kudchadkar, EU PARK-PICU Collaborators, Paul C. Ritson, F. Nikolaou, Marjorie de Neef, Martin C. J. Kneyber, Kate Penny-Thomas, Christina Linton, Reinis Balmaks, Matthias Richter, Fabrizio Chiusolo, Corrado Cecchetti, Marco Roberti, Michela Di Furia, Chantal Grandjean, Bettina Nygaard, Yolanda López, Tolga Köroğlu, Tolga Besci, Roberta Da Rin Della Mora, Rachel Agbeko, Emma Borrows, Nathalie Bochaton, Janet Mattsson, Anne Ksellmann, Barbara Hero, Jowita Rosada-Kurasińska, Magdalena Świder, Amabile Bonaldi, Cristina Giugni, Siva Oruganti, Simon Gates, Hazel Smith, Annelies van Zwol, J. Hills, Johanna Conroy, Mark B. Bebbington, Felix Neunhoeffer, E Duval
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.