Pediatric Intensive Care Unit, Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Perm J. 2023 Dec 15;27(4):25-35. doi: 10.7812/TPP/23.010. Epub 2023 Sep 11.
Patients admitted to the pediatric Intensive Care Unit (PICU) are frequently sedated, restrained, and placed on bed rest. These practices have known negative impacts including prolonged hospital stay and diminished functional status after discharge. The authors' objective was to investigate the impact of a PICU early mobility protocol on the frequency of orders for physical, occupational, and speech therapy (PT, OT, ST) and improvement in patient functional status.
Patients admitted in 2019 prior to the development of the PICU early mobility protocol were compared to those admitted in 2020 who underwent the protocol. Differences in clinical characteristics; PICU length of stay; rates of PT, OT, and ST orders; rates of bedside mobility activities; and functional status scores (FSSs) were assessed in bivariate and multivariate analyses. The protocol included early PT, OT, and ST order placement and frequent in-room mobility activities.
Of the 384 patients included in the study, 216 (56%) were preprotocol patients, and 168 (44%) underwent the protocol. Patients in 2020 were more likely to receive a physical therapy order compared to their 2019 counterparts (79% vs 47%, p < 0.001). Patients in 2020 had a higher daily incidence of mobility activities compared to those in 2019 (4.88 activities vs 4.1 activities, p < 0.001). Changes in functional status scores were similar between the 2 groups.
PICU early mobility was associated with increased physical, occupational, and speech therapy orders and daily mobility activities but was not associated with a reduction in functional morbidity at discharge or 3 months post-discharge.
入住儿科重症监护病房（PICU）的患者经常会接受镇静、约束和卧床休息。这些做法已知会产生负面影响，包括住院时间延长和出院后功能状态下降。作者的目的是调查 PICU 早期活动方案对物理治疗、职业治疗和言语治疗（PT、OT、ST）医嘱频率的影响以及对患者功能状态的改善。
比较了在制定 PICU 早期活动方案之前（2019 年）和实施该方案期间（2020 年）入院的患者。在单变量和多变量分析中评估了临床特征差异、PICU 住院时间、PT、OT 和 ST 医嘱率、床边活动率和功能状态评分（FSS）。该方案包括早期 PT、OT 和 ST 医嘱的下达以及频繁的室内活动。
在纳入研究的 384 名患者中，216 名（56%）为方案前患者，168 名（44%）接受了方案。与 2019 年相比，2020 年接受物理治疗医嘱的患者更多（79% vs 47%，p<0.001）。与 2019 年相比，2020 年患者每天的活动量更高（4.88 次 vs 4.1 次，p<0.001）。两组患者的功能状态评分变化相似。
PICU 早期活动与增加物理治疗、职业治疗和言语治疗医嘱以及日常活动量有关，但与出院时或出院后 3 个月的功能发病率降低无关。
