Ghafoor Saad, Fan Kimberly, Williams Sarah, Brown Amanda, Bowman Sarah, Pettit Kenneth L, Gorantla Shilpa, Quillivan Rebecca, Schwartzberg Sarah, Curry Amanda, Parkhurst Lucy, James Marshay, Smith Jennifer, Canavera Kristin, Elliott Andrew, Frett Michael, Trone Deni, Butrum-Sullivan Jacqueline, Barger Cynthia, Lorino Mary, Mazur Jennifer, Dodson Mandi, Melancon Morgan, Hall Leigh Anne, Rains Jason, Avent Yvonne, Burlison Jonathan, Wang Fang, Pan Haitao, Lenk Mary Anne, Morrison R Ray, Kudchadkar Sapna R
Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Department of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States.
Front Oncol. 2021 Mar 8;11:645716. doi: 10.3389/fonc.2021.645716. eCollection 2021.
Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.
We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.
Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.
Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.
患有基础肿瘤和血液疾病且需要重症监护服务的儿童，在发生儿科重症监护后综合征（PICS-p）导致功能障碍方面具有独特的风险因素。早期活动和康复计划为减轻肿瘤患者PICS-p的影响提供了一种有前景的方法，但尚未在这一高风险人群中进行研究。
我们描述了在一个专门的儿科肿瘤重症监护病房实施早期活动质量改进计划的制定过程和可行性。我们的主要结果包括入院72小时内接受康复服务咨询的患者百分比、入院72小时内开始活动的患者百分比，以及入院48小时后谵妄筛查呈阳性的患者百分比。
在2019年1月至2020年6月期间，我们显著提高了入院72小时内接受康复服务咨询的患者比例，从25%提高到56%（<0.001），将重症监护病房入院72小时内开始活动的患者百分比从21%提高到30%（=0.02），并观察到谵妄筛查呈阳性的患者从43%下降到37%（=0.46）。早期活动计划与非计划拔管、中心静脉导管意外拔除或患者及工作人员受伤的增加无关。
我们的经验支持了儿科肿瘤重症监护中早期活动计划的安全性和可行性。需要进一步评估以确定早期活动对患者结局的影响。
