Objective To determine the safety and feasibility of an early mobilization program in a pediatric intensive care unit (PICU). Design Observational, pre-post design. Setting PICU in a tertiary academic hospital in the United States. Patients Critically ill pediatric patients admitted to the PICU. Intervention This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children. Measurements and Main Results Data was collected and analyzed from July to August 2014 (pre-implementation phase) and July to August 2015 (post-implementation). The study sample included 200 children aged 1 day through 17 years who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p=0.034) and physical therapy consultations (54% vs. 66%; p=0.08) by PICU day 3. The median number of mobilizations per patient by PICU Day 3 increased from 3 to 6 (p<0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p<0.001) and ambulation (p=0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff. Conclusions Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children’s care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.

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A s a hospital-acquired infection (HAI), ventilator-associated pneumonia (VAP) is associated with additional complications for patients in the pediatric intensive care unit (PICU). Despite the volume of published information on VAP in adults, the amount of research on VAP in children is limited. Health care providers need to be aware of the risk for VAP in infants and children and should have preventive programs in place. Evidence-based protocols that outline preventive and therapeutic treatments for specific situations for adults treated with mechanical ventilation have been developed, but little has been offered for the care of children receiving mechanical ventilation. Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little research has been done in children to identify necessary skills and strategies. Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit. Following the recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this important health care problem. (Critical Care Nurse. 2013;33[3]:21-30) by AACN on May 12, 2018 http://ccn.aacnjournals.org/ Downloaded from

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