Early Mobilization in Pediatric Critical Care: Exploring the Gap between Theory and Practice in Saudi Arabia

Abstract

Background:Advancements in critical care have improved survival rates for children in PICUs, but many survivors suffer long-term morbidity and lower quality of life due to ICU-acquired weakness, cognitive impairment, and immobility-related issues. Early mobilization (EM) is a promising intervention to reduce these negative consequences. This study evaluates the knowledge, views, and practices of physicians and care providers regarding EM in Saudi Arabia's pediatric critical care units. Study Design: A survey was conducted from July 2020 to February 2021 to gather information on early mobilization practices for critically ill children in the pediatric intensive care unit in Saudi Arabia. The survey was sent to 110 doctors, 200 nurses, 30 respiratory therapists, and 20 physiotherapists. The survey aimed to explore rehabilitation aspects, including the challenges faced during early mobilization, suitable timing and types of rehabilitation, and healthcare personnel workload. Results:A survey with a 72.78% response rate, primarily from registered nurses (65.7%), indicated strong support for early mobilization in Pediatric Intensive Care Unit (PICU) patient care among healthcare professionals. Over 80% of respondents considered it crucial or important. However, institutional and healthcare provider-level barriers exist, including lack of equipment (63.5%), medical instability (67.3%), endotracheal intubation (65.4%), and limited staff (56.4%). Concerns about safety (47.4%) and insufficient physical space (38.9% physicians, 24.7% non-physicians) were also raised. Routine bed rest orders upon PICU admission were more common among non-physicians (26.8%) compared to physicians (12.5%). As illness severity increased, clinicians' comfort with early mobilization decreased. Most common rehabilitation interventions were respiratory physiotherapy and passive range of motion (77.8%). Healthcare professionals in Saudi Arabia regularly use daily sedation interruptions in pediatric ICUs. However, only 38.7% of respondents referred patients with suspected ICU-acquired weakness to outpatient clinics for long-term rehabilitation. Conclusion: Early mobilization is crucial in pediatric critical care in Saudi Arabia, but its implementation faces challenges. Healthcare institutions must navigate these challenges with strategic intent and a multidisciplinary ethos. Future research should focus on optimal timelines and interventions tailored to specific pediatric cohorts. This approach can improve patient outcomes and elevate the caliber of pediatric critical care, refining healthcare quality and providing a blueprint for excellence globally.