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. 2022 Apr 1;149(4):e2021053432.
doi: 10.1542/peds.2021-053432.

Mobilization Safety of Critically Ill Children

Jessica M LaRosa  1 , Archana Nelliot  2 , Munfarid Zaidi  2 , Dhananjay Vaidya  3 , Ronke Awojoodu  1 , Sapna R Kudchadkar  1   4   5
Affiliations

Mobilization Safety of Critically Ill Children

Jessica M LaRosa et al. Pediatrics. .

Abstract

Background: Children in PICUs experience negative sequelae of immobility; however, interprofessional staff concerns about safety are a barrier to early mobilization. Our objective was to determine the safety profile of early mobilization in PICU patients.

Methods: We conducted a secondary analysis of a 2-day study focused on physical rehabilitation in 82 PICUs in 65 US hospitals. Patients who had ≥72-hour admissions and participated in a mobility event were included. The primary outcome was occurrence of a potential safety event during mobilizations.

Results: On 1433 patient days, 4658 mobility events occurred with a potential safety event rate of 4% (95% confidence interval [CI], 3.6%-4.7%). Most potential safety events were transient physiologic changes. Medical equipment dislodgement was rare (0.3%), with no falls or cardiac arrests. Potential safety event rates did not differ by patient age or sex. Patients had higher potential safety event rates if they screened positive for delirium (7.8%; adjusted odds ratio, 5.86; 95% CI, 2.17-15.86) or were not screened for delirium (4.7%; adjusted odds ratio, 3.98; 95% CI, 1.82-8.72). There were no differences in potential safety event rates by PICU intervention, including respiratory support or vasoactive support.

Conclusions: Early PICU mobilization has a strong safety profile and medical equipment dislodgement is rare. No PICU interventions were associated with increased potential safety event rates. Delirium is associated with higher potential safety event rates. These findings highlight the need to improve provider education and confidence in mobilizing critically ill children.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Potential safety event rate by staff involvement in mobilization (A) and highest level of mobility achieved (B). Numbers above the bars represent the total number of mobility events that each group participated in. NP, nurse practitioner; ROM, range of motion.
FIGURE 2
FIGURE 2
aORs for potential safety events. The multivariable model included random effect for site, adjusted for age, gender, ethnicity, PICU LOS, nurse-to-patient ratio, admission reason, and respiratory support in addition to all characteristics listed. Vasoactive infusion excluded milrinone. PCPC, pediatric cerebral performance category; RN, registered nurse. *P-value ≤.05.
See this image and copyright information in PMC

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