Abdulsatar et al.(1414 Abdulsatar F, Walker RG, Timmons BW, Choong K. "Wii-Hab" in critically ill children: a pilot trial. J Pediatr Rehabil Med. 2013;6(4):193-204.)
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9.5 (1 - 56) days |
Hemodynamic instability; deep sedation; contraindication for mobilization (e.g., surgery in ULs); severe cognitive or functional disability (POPC and PCPC ≥ 4); on life support |
Interactive videogame Nintendo Wii ™ Boxing - Sport Pack 2 times/day, minimum 10 minutes |
Increased movement of the ULs versus the remainder of the day (p = 0.049) No difference in grip strength (p = 0.20) 75% did not complete the 2-day intervention protocol due to excessive sedation, pediatric ICU transfer or refusal by the parents/patient Limitation of intervention viability due to restricted number of eligible patients |
Choong et al.(1515 Choong K, Chacon MD, Walker RG, Al-Harbi S, Clark H, Al-Mahr G, et al. In-bed mobilization in critically ill children: a safety and feasibility trial. J Pediatr Intensive Care. 2015;4(4):225-34.)
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4 (2 -10) days |
Hemodynamic and ventilatory instability; active patients or at their baseline level of functionality; imminent risk of death; on life support; cerebral edema, elevated intracranial pressure, unstable spinal cord injuries; musculoskeletal injuries, surgical contraindications and deformities Interruption criteria: bradycardia, tachycardia, hypotension, persistent hypertension, SpO2<85% or increased work of breathing; pain or discomfort; drain and tube dislodgement |
Interactive videogame for cooperative and conscious patients. Nintendo Wii™ Sport Pack and Mario Kart Cycle cyclometer passive exercise for LLs for noncooperative patients Ex N’Flex EF-300 (3 - 7 years) MOTOmedLetto2 (8 - 17 years) Day 1: 10 - 20 minutes Day 2: 20 minutes |
Passive mobilization with cycle ergometer increased the activity of the LLs (p <0.001) Safe when applied to noncooperative children Activities with interactive videogames are viable only in a minority of children and did not increase the movement of the ULs (p> 0.05) |
Wieczorek et al.(1717 Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, et al. PICU Up!: Impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med. 2016;17(12):e559-66.)
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First 72 hours after admission |
ECMO; unstable fracture; thorax or abdomen exposed; medical orientation Break/reevaluation criteria: 20% change in HR, BP or RR; 15% decrease in SpO2; Need to increase FiO2 by 20%; increase in ETCO2 by 20%; work of breathing; new arrhythmia; change in mental state; agitation; concern with OTT/TQT, vascular access or EVD |
LEVEL 1 (MV FiO2> 0.6 or PEEP> 8, difficult intubation, recent TQT, acute neurological event, vasopressor, sedation or SBS -3 and -2): Lights on 9am - 11pm Television 2 hours/day > 2 years Elevated headboard ≥ 30 Change in position Positioning Physical therapy initiation Evaluation by the occupational therapist after 72 hours LEVEL 2 (MV FiO2 ≤ 0.6 or PEEP ≤ 8 and SBS -1 and +3 or NIV FiO2 > 0.6, dialysis/renal replacement therapy or femoral access): Positive touch Sitting up in bed 3 times/day Consider out of bed to chair and/or ambulation Assessment by the speech pathologist Evaluation of delirium 2 times/day. LEVEL 3 (NIV FiO2 ≤ 0.6 or baseline pulmonary support or external ventricular drain and SBS -1 and +3): Out of bed to chair 3 times/day or sitting up in bed Ambulation 2 times/day if trunk control present |
Increase in the number of physical therapy and occupational therapy consultations with the implementation of the early mobilization program The mean number of mobilization activities per patient on the 3rd day doubled from 3 (2 - 5) to 6 (3 - 7.5)b (p < 0.01) |
Choong et al.(1818 Choong K, Awladthani S, Khawaji A, Clark H, Borhan A, Cheng J, Laskey S, Neu C, Sarti A, Thabane L, Timmons BW, Zheng K, Al-Harbi S; Canadian Critical Care Trials Group. Early exercise in critically ill youth and children, a preliminary evaluation: The wEECYCLE Pilot Trial. Pediatr Crit Care Med. 2017;18(11):e546-54.)
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2 (1 - 4) days |
Hemodynamic, ventilatory and/or neurological instability; surgical contraindications Interruption criteria: SpO2 < 88% despite an increase in FiO2; tachycardia, bradycardia and persistent hypotension, arrhythmia; increase in blood pressure 25%; increased work of breathing; discomfort or pain |
Intervention: standard treatment + cycle ergometer RT300 Supine Cycle Ergometer 30 minutes - 5 times/week Control: standard treatment according to the institutional routine of early mobilization
Participants were mobilized at increasing levels individually according to the necessary assistance and could involve activities such as positioning, passive exercises, active exercises, muscle strengthening, transfers, changes in position, sitting periods |
Early mobilization is safe and viable In-bed mobilization with a cycle ergometer can optimize the duration and intensity of mobilization in previously healthy children with pre-existing functional limitations |
Tsuboi et al.(2525 Tsuboi N, Nozaki H, Ishida Y, Kanazawa I, Inamoto M, Hayashi K, et al. Early mobilization after pediatric liver transplantation. J Pediatr Intensive Care. 2017;6(3):199-205.)
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From the 1st PO day |
Hemodynamic instability; PO immediately after thoracic or abdominal surgery; intracranial hypertension; cervical spinal instability |
Daily planning of the level of mobilization for each patient with the team: range-of-motion exercises; sitting on the bed; transfer to a chair; orthostasis; ambulation
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Increase in the proportion of patients who received physical therapy after the implementation of the early mobilization program (p < 0.001) No difference in the time of intubation, length of stay on the pediatric ICU and length of hospital stay The mobilization was well tolerated and safe |
Betters et al.(2626 Betters KA, Hebbar KB, Farthing D, Griego B, Easley T, Turman H, et al. Development and implementation of an early mobility program for mechanically ventilated pediatric patients. J Crit Care. 2017;41:303-8.)
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Daily assessment of patients under MV |
Absolute: high-frequency oscillatory ventilation; neuromuscular blocking agent; difficult airway; unstable TBI Relative: FiO2 > 0.5 or rapid increase; PEEP > 8; sedation level < 2; hemodynamic instability; vertebral injury |
Active mobilization of patients under MV 10 - 60 minutes/day according to tolerance |
Significant difference in the professionals’ perception about mobilization Increased number of consultations The implementation of a multidisciplinary protocol and the training of the team enabled the early mobilization of pediatric patients under MV in the pediatric ICU |