OP070 [Critical Care Rehabilitation » Rehabilitation]: EARLY REHABILITATION IN CRITICALLY ILL CHILDREN – A MULTI-SITE IMPLEMENTATION STUDY

Abstract

not mobilized had PICU LOS less than 24 hours and 12.2% of patients were not mobilized for medical reasons. There was no statistical difference between PICU LOS (pre-EM: 11.7±15.7 days, post-EM: 8.3±13.9 days, p=.187) and hospital LOS (pre-EM: 37.7±43.7 days, post-EM: 33.9±51.6 days, p=.986) between both cohorts. CONCLUSIONS:The early mobilization program was associated with significant improvements in the percentage of patients mobilized and time to mobilization.

Moving Away From Randomized Controlled Trials to Hybrid Implementation Studies for Complex Interventions in the PICU*

“…What we also learn from the study by Choong et al (5) is that generating change is usually more challenging than maintaining the status quo, particularly if innovations necessitate complex changes in clinical practice, interdisciplinary collaboration, or reorganization of care. In this context, early mobilization is an example of a complex intervention because it must align with treatment of pain and sedation, and delirium management.…”

“…Traditionally, critically ill children were kept immobile and deeply sedated to prevent instability and therefore were not mobilized. Studying both the effectiveness and the implementation outcomes of this bundle as done by Choong et al (5) in a hybrid trial design is-we believe-the next step to facilitate the implementation and its evaluation of early mobilization in PICU practice. Indeed, this recent work follows a bundle with other components.…”

“…Future research should focus on sustainability, scalability, and economic evaluations for broader adoption of early mobilization programs. Erin Talati Paquette, MD, JD, MBe [3][4][5] KEY WORDS: communication; pediatric critical care; post-intensive care syndrome P arents of critically ill children face many challenges during their PICU admission and thereafter. The study by Tager et al (1) in this issue of Pediatric Critical Care Medicine is an important article that highlights real-time challenges faced by parents of critically ill children as perceived by support personnel called "navigators".…”

“…In this issue of Pediatric Critical Care Medicine , Choong et al (5) present a two-center study in what they call “a hybrid implementation study” to evaluate both implementation and clinical patient outcomes, that is, a hybrid type 2 design (6). The authors’ bundle of care consisted of three components: 1) pain and sedation management; 2) delirium management; and 3) early mobility activities.…”

“…Daily goal-setting for mobilizing patients improved in both sites from 2% to 62.8% and 36.1 to 80%, respectively. Nevertheless, the implementation of the bundle did not have a significant positive impact on the clinical outcomes, probably because of small sample sizes (5). However, we speculate the possibility that early mobilization has other potential benefits after the PICU stay, such as shorter rehabilitation and less risk of post intensive care syndrome.…”