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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Care | Research

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

Authors: 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

Published in: Critical Care | Issue 1/2020

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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.

Graphical abstract

Appendix
Available only for authorised users
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Metadata
Title
Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)
Authors
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
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-02988-2

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