TY - JOUR
T1 - Mobilization practices in critically ill children: A European point prevalence study (EU PARK-PICU)
AU - Ista, Erwin
AU - Ista, Erwin
AU - Scholefield, Barnaby R.
AU - Scholefield, Barnaby R.
AU - Manning, Joseph C.
AU - Manning, Joseph C.
AU - Harth, Irene
AU - Gawronski, Orsola
AU - Bartkowska-Śniatkowska, Alicja
AU - Ramelet, Anne-Sylvie
AU - Kudchadkar, Sapna R.
AU - Kudchadkar, Sapna R.
AU - Kudchadkar, Sapna R.
AU - Ritson, Paul C.
AU - Nikolaou, Filippia
AU - de Neef, Marjorie
AU - Kneyber, Martin
AU - Penny-Thomas, Kate
AU - Linton, Christina
AU - Balmaks, Reinis
AU - Richter, Matthias
AU - Chiusolo, Fabrizio
AU - Cecchetti, Corrado
AU - Roberti, Marco
AU - di Furia, Michela
AU - Grandjean, Chantal
AU - Nygaard, Bettina
AU - Lopez, Yolanda
AU - Koroglu, Tolga
AU - Besci, Tolga
AU - Mora, Roberta Da Rin Della
AU - Agbeko, Rachel S.
AU - Borrows, Emma
AU - Bochaton, Nathalie
AU - Mattsson, Janet
AU - Ksellmann, Anne
AU - Hero, Barbara
AU - Rosada-Kurasinska, Jowita
AU - Świder, Magdalena
AU - Bonaldi, Amabile
AU - Giugni, Cristina
AU - Oruganti, Siva
AU - Gates, Simon
AU - Smith, Hazel
AU - van Zwol, Annelies
AU - Hills, Jenna
AU - Conroy, Johanna
AU - Bebbington, Mark
AU - Neunhoeffer, Felix
AU - Duval, Els
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. Graphical abstract: [Figure not available: see fulltext.]
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. Graphical abstract: [Figure not available: see fulltext.]
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 - https://doi.org/10.1186/s13054-020-02988-2
DO - https://doi.org/10.1186/s13054-020-02988-2
M3 - Article
C2 - 32576273
SN - 1364-8535
VL - 24
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 368
ER -