Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Department of Paediatric Intensive Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
BMJ Paediatr Open. 2022 Jun;6(1). doi: 10.1136/bmjpo-2021-001300.
To understand the context and professional perspectives of delivering early rehabilitation and mobilisation (ERM) within UK paediatric intensive care units (PICUs).
A web-based survey administered from May 2019 to August 2019.
UK PICUs.
A total of 124 staff from 26 PICUs participated, including 22 (18%) doctors, 34 (27%) nurses, 28 (23%) physiotherapists, 19 (15%) occupational therapists and 21 (17%) were other professionals.
Key components of participants' definitions of ERM included tailored, multidisciplinary rehabilitation packages focused on promoting recovery. Multidisciplinary involvement in initiating ERM was commonly reported. Over half of respondents favoured delivering ERM after achieving physiological stability (n=69, 56%). All age groups were considered for ERM by relevant health professionals. However, responses differed concerning the timing of initiation. Interventions considered for ERM were more likely to be delivered to patients when PICU length of stay exceeded 28 days and among patients with acquired brain injury or severe developmental delay. The most commonly identified barriers were physiological instability (81%), limited staffing (79%), sedation requirement (73%), insufficient resources and equipment (69%), lack of recognition of patient readiness (67%), patient suitability (63%), inadequate training (61%) and inadequate funding (60%). Respondents ranked reduction in PICU length of stay (74%) and improvement in psychological outcomes (73%) as the most important benefits of ERM.
ERM is gaining familiarity and endorsement in UK PICUs, but significant barriers to implementation due to limited resources and variation in content and delivery of ERM persist. A standardised protocol that sets out defined ERM interventions, along with implementation support to tackle modifiable barriers, is required to ensure the delivery of high-quality ERM.
了解英国儿科重症监护病房（PICU）中早期康复和动员（ERM）的背景和专业观点。
2019 年 5 月至 8 月期间进行的基于网络的调查。
英国 PICU。
共有 26 个 PICU 的 124 名工作人员参与了这项研究，包括 22 名（18%）医生、34 名（27%）护士、28 名（23%）物理治疗师、19 名（15%）职业治疗师和 21 名（17%）其他专业人员。
参与者对 ERM 的定义的关键组成部分包括针对促进康复的量身定制的多学科康复方案。多学科参与启动 ERM 是常见的。超过一半的受访者倾向于在达到生理稳定后提供 ERM（n=69，56%）。所有年龄组都由相关的卫生专业人员考虑进行 ERM。然而，在启动时间方面的反应不同。干预措施更有可能在 ICU 住院时间超过 28 天且患有获得性脑损伤或严重发育迟缓的患者中提供 ERM。最常被识别的障碍是生理不稳定（81%）、人员配备有限（79%）、镇静要求（73%）、资源和设备不足（69%）、缺乏对患者准备情况的认识（67%）、患者适宜性（63%）、培训不足（61%）和资金不足（60%）。受访者将 ICU 住院时间缩短（74%）和心理结局改善（73%）列为 ERM 的最重要益处。
ERM 在英国 PICU 中越来越受到认可和支持，但由于资源有限以及 ERM 的内容和实施方式存在差异，实施仍存在重大障碍。需要制定一个标准化的方案，规定明确的 ERM 干预措施，并提供实施支持以解决可改变的障碍，以确保提供高质量的 ERM。
