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Choong, K.1; Chacon, M.2; Walker, R.3; Al-Harbi, S.2; Clark, H.2; Al-Mahr, G.2; Timmons, B.2; Thabane, L.1
1Pediatrics Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada 2Pediatrics, McMaster University, Hamilton, Canada 3Child Health and Exercise Medicine, McMaster University, Hamilton, Canada
Background and aims: Early mobilization of critically ill adults appears to be safe, feasible, and improves patient outcomes. In contrast, there is a paucity of research in pediatrics.
Aims: Our objective in this prospective cohort study was to evaluate the safety and feasibility of early rehabilitation in the pediatric critical care unit (PCCU) setting, using a combination of individualized mobility interventions.
Methods: This study was IRB approved. We applied either a passive (cycle ergometer) and/or active (interactive video-gaming) mobility interventions to hemodynamically stable PCCU patients aged 3–18 years. Interventions were applied based on their functional and cognitive ability, i.e. unconscious or non-cooperative patients received cycle-ergometry, while video-gaming was applied once the patient could cooperate. Each intervention was applied for a maximum of 2 days. Primary outcomes were feasibility and safety.
Results: We enrolled 25 patients between June 2012–2013, 13 (52%) of whom were male. 21 (84%) received cycle ergometry and 16% participated with video-gaming. 52% patients were mechanically ventilated during the intervention. Cardiorespiratory parameters remained stable during the interventions. There were no accidental tube dislodgements, reported changes in pain or sedation requirements, or other adverse events during the study period. One patient with stimulus sensitive seizures on continuous electroencephalographic monitoring did not experience any seizures, while another with intracranial pressure (ICP) monitoring, did not exhibit ICP changes, during the intervention.
Conclusions: This pilot study suggests that it is feasible to apply these novel methods of early mobilization in the PCCU setting, without evidence of adverse events.
©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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