Joyce Christine L, Taipe Cosme, Sobin Brittany, Spadaro Marissa, Gutwirth Batsheva, Elgin Larissa, Silver Gabrielle, Greenwald Bruce M, Traube Chani
Department of Pediatrics, NewYork-Presbyterian Hospital, USA.
Department of Nursing, New York-Presbyterian Hospital, USA.
J Pediatr Nurs. 2018 Jan-Feb;38:15-19. doi: 10.1016/j.pedn.2017.10.003. Epub 2017 Oct 14.
Critically ill patients are at risk for short and long term morbidity. Early mobilization (EM) of critically ill adults is safe and feasible, with improvement in outcomes. There are limited studies evaluating EM in pediatric critical care patients. Provider beliefs and concerns must be evaluated prior to EM implementation in the pediatric intensive care unit (PICU).
A survey was distributed to PICU providers assessing beliefs and concerns with regards to EM of PICU patients.
Seventy-one providers responded. Most staff believed EM would be beneficial. The largest perceived benefits were decreased length of both stay and mechanical ventilation. The largest perceived concerns were risk of both endotracheal tube and central venous catheter dislodgement. Surveyed clinicians felt significantly more comfortable mobilizing the oldest as compared to the youngest patients (p<0.0001). Clinicians also felt significantly more comfortable mobilizing patients receiving invasive mechanical ventilation in the oldest as compared to the youngest patients (p<0.0001).
There is clear benefit to the EM of adult ICU patients, with evidence supporting its safety and feasibility. As pediatric patients pose different challenges, it is imperative to understand provider concerns prior to the implementation of EM. Our research demonstrates similar concerns between adult and pediatric programs, with the addition of significant concern surrounding EM in very young children.
Understanding pediatric specific concerns with regards to EM will allow for the proper development and implementation of pediatric EM programs, allowing us to assess safety, feasibility, and ultimately outcomes.
危重症患者面临短期和长期发病风险。危重症成年患者的早期活动（EM）是安全可行的，且能改善预后。评估儿科重症监护患者EM的研究有限。在儿科重症监护病房（PICU）实施EM之前，必须评估医护人员的信念和担忧。
向PICU医护人员发放一份调查问卷，评估他们对PICU患者EM的信念和担忧。
71名医护人员做出回应。大多数工作人员认为EM有益。最大的预期益处是缩短住院时间和机械通气时间。最大的预期担忧是气管内导管和中心静脉导管移位的风险。与最年幼的患者相比，接受调查的临床医生在为最年长的患者进行活动时感觉明显更自在（p<0.0001）。与最年幼的患者相比，临床医生在为接受有创机械通气的最年长患者进行活动时也感觉明显更自在（p<0.0001）。
成人ICU患者进行EM有明显益处，有证据支持其安全性和可行性。由于儿科患者带来不同的挑战，在实施EM之前了解医护人员的担忧至关重要。我们的研究表明成人和儿科项目存在类似的担忧，此外对非常年幼患儿的EM存在重大担忧。
了解儿科对EM的特定担忧将有助于正确制定和实施儿科EM项目，使我们能够评估安全性、可行性以及最终的预后。
