Development and implementation of an early mobility program for mechanically ventilated pediatric patients

Betters, Kristina; Hebbar, Kiran; Farthing, David; Griego, Brittany; Easley, Tricia; Turman, Hartley; Perrino, Lauren; Sparacino, Stephanie; DeAlmeida, Mary

doi:10.1016/j.jcrc.2017.08.004

Cited by 42 publications

(60 citation statements)

References 29 publications

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“…Betters et al 19 The development of an Early Mobility (EM) protocol made EM more feasible for pediatric patients receiving mechanical ventilation, therefore improving early mobility for critically ill pediatric patients.…”

Section: Key Findingsmentioning

confidence: 99%

Quality improvement in pediatric intensive care: A systematic review of the literature

Kourtis

Burns

2019

Pediatric Investigation

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Importance Measuring and improving performance is an essential component of any high‐risk industry, including intensive care medicine. We undertook this systematic review to describe the current state of quality improvement efforts in pediatric intensive care medicine. Objective To evaluate the quality and rigor of all published literature on quality improvement efforts in the pediatric intensive care unit in the current era. Methods We conducted a literature search on MEDLINE, Embase, and Cochrane for studies that met two broad inclusion criteria: 1) the terms “pediatric critical care” and “quality improvement” and 2) they were completed in the past ten years. In the initial search, we also included academic and professional societies or organizations devoted to providing resources on quality improvement in intensive care medicine. We excluded studies that examined quality improvement processes exclusively for neonatal or adult patients receiving intensive care. Results Forty‐nine of 332 identified articles were selected for final review by two reviewers who independently rated the quality of the methodology and rigor of the evidence reported for each study. Of these, 23 studies targeted structural issues, 14 studies targeted process issues, and 12 targeted an outcome as the focus of the intensive care quality improvement effort. Interpretation Our review of the published literature on quality improvement efforts in the pediatric intensive care unit in the current era found that 85% of studies were limited in methodology or analysis. Fifteen high‐quality studies are reported here and serve as helpful examples of rigorous research methodology in this domain going forward.

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Section: Key Findingsmentioning

confidence: 99%

Quality improvement in pediatric intensive care: A systematic review of the literature

Kourtis

Burns

2019

Pediatric Investigation

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“…Researchers and clinicians are beginning to recognize the importance of sedation protocols (Curley et al, 2015), sleep promotion (Kawai et al, 2017), early mobility (Betters et al, 2017), and increased family presence (Harrison, 2010) in pediatric intensive care, however the impact of these interventions on the incidence and duration of delirium remains unknown. Attempts to facilitate widespread implementation of these interventions and increase the prevention and treatment of delirium in pediatric populations will not be successful without the leadership and collaboration of bedside nurses.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

“…Children less than 5 years of age appear to be especially at risk for delirium, as are children who are developmentally delayed, have a high severity of illness, are mechanically ventilated, or receive benzodiazepines (Holly, Porter, Echevarria, Dreker, & Ruzehaji, 2018;Mody et al, 2018;Silver et al, 2015;Smith et al, 2017;Traube, Silver, Gerber, et al, 2017). While efforts have been made to implement sedation protocols (Curley et al, 2015), sleep promotion (Kawai et al, 2017), early mobility (Betters et al, 2017), and increased family presence (Harrison, 2010) in pediatric intensive care, it remains unknown if there is a resulting decrease in the incidence or duration of delirium. Long-term effects of pediatric delirium are unknown, but children with delirium have an increased duration of mechanical ventilation, PICU length of stay, and risk for mortality (Silver et al, 2015;Smith et al, 2017;Traube, Silver, Gerber, et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

Kalvas

2019

Journal of Clinical Nursing

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Aims and Objectives: The purpose of this article is to create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of pediatric delirium. Background: Delirium in the pediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay, and mortality. Nurses are uniquely positioned at the bedside to identify, prevent, and treat delirium. An understanding of the potential long-term consequences of pediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory. Design: Critical review of the literature through application and critique of the Life Course Health Development Model in the context of pediatric delirium. Gaps in the current understanding of pediatric delirium, as well as future directions for research and practice, are discussed. Methods: The seven core principles of the model are considered in the context of pediatric delirium. Each of the principles has the potential to further understanding of pediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change. Conclusions: The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory. Relevance to Clinical Practice: By emphasizing the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research, and practice change among pediatric clinicians and researchers.

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“…However, that pool is growing, with new publications focused on quality-improvement initiatives and establishment of medical criteria for PICU mobilization. 15,16 It is important to point out that this is not the first systematic review conducted on pediatric acute rehabilitation-in fact, it is the third in 4 years. 17,18 The take-home from all of these reviews has been consistent-it's time to study the outcomes.…”

Section: See Related Article P 25mentioning

confidence: 99%

Early Mobility in the Pediatric Intensive Care Unit: Can We Move On?

Walker

Kudchadkar

2018

The Journal of Pediatrics

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Development and implementation of an early mobility program for mechanically ventilated pediatric patients

Cited by 42 publications

References 29 publications

Quality improvement in pediatric intensive care: A systematic review of the literature

Quality improvement in pediatric intensive care: A systematic review of the literature

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

Early Mobility in the Pediatric Intensive Care Unit: Can We Move On?

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