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Benefits of Early Mobilization After Pediatric Liver Transplantation*

Tsuboi, Norihiko, MD1; Hiratsuka, Miku, RN1; Kaneko, Setsushi, RN1; Nishimura, Nao, MD1; Nakagawa, Satoshi, MD1; Kasahara, Mureo, MD, PhD2; Kamikubo, Takeshi, MD, PhD3

Pediatric Critical Care Medicine: February 2019 - Volume 20 - Issue 2 - p e91–e97
doi: 10.1097/PCC.0000000000001815
Online Clinical Investigations

Objective: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU.

Design: A 70-month retrospective before-after study.

Setting: Medical and surgical PICU with 20 beds at a tertiary children’s hospital.

Patients: Seventy-five patients 2–18 years old who underwent liver transplantation and could walk before surgery.

Intervention: We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach.

Measurements and Main Results: There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0–10.6 min] vs 17.4 min [13.2–26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16–66] vs 23 [19–31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37–99] vs 40 [31–54] postoperative days; p = 0.012).

Conclusions: Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.

1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.

2Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.

3Rehabilitation Medicine, National Center for Child Health and Development, Tokyo, Japan.

*See also p. 209.

Drs. Tsuboi and Kasahara received a grant from the National Center for Child Health and Development (30–2). The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at the National Center for Child Health and Development.

Address requests for reprints to: Norihiko Tsuboi, MD, Critical Care Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 8535, Japan. E-mail: tsuboi-n@ncchd.go.jp

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies