Prise en charge de la mobilisation précoce en réanimation, chez l’adulte et l’enfant (électrostimulation incluse)

Roeseler, Jean; Sottiaux, Thierry; Lemiale, Virginie; Lesny, M.; Béduneau, G.; Bialais, Émilie; Bradaï, N.; Castelain, Vincent; Dinomais, Mickaël; Dousse, Nicolas; Fontaine, Larissa de la; Guérin, Claude; Hickmann, C.; Jougleux, Muriel; Kouki, Sami; Leboucher, F.; Lemaire, Muriel; Nassaj, Anas; Nunes, J.; Robain, G.; Thiollière, Fabrice; Thivellier, A.; Wittebole, Xavier; Osman, David; Bretonnière, Cédric; Boulain, Thierry; Chaoui, K.; Cravoisy, A.; Silva, D. Da; Djibré, Michel; Fieux, Fabienne; Hurel, Dilek Mete; Lesieur, Olivier; Milési, Christophe; Misset, Benoît; Quenot, Jean‐Pierre; Soufir, Lilia; Vong, Ly Van; Titomanlio, Luigi

doi:10.1007/s13546-013-0658-y

Cited by 34 publications

(11 citation statements)

References 68 publications

(112 reference statements)

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“…24,50,57 Evidence on the safety of EM in critically ill children is derived from observational studies (level 3), 12,21,23,38,39,58,59 or are opinion based. 60 This evidence to date demonstrates that EM is safe and feasible in critically ill children receiving mechanical ventilatory support, invasive monitoring, sedative and vasoactive infusions. Based on these data, we developed a system-based set of clinical safety criteria that prioritizes maintaining cardiorespiratory and neurologic stability and preventing patient discomfort and device dislodgement (►Table 3).…”

Section: Rationalementioning

confidence: 89%

Practice Recommendations for Early Mobilization in Critically Ill Children

Choong

Canci

Clark

et al. 2017

J Pediatr Intensive Care

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Prolonged immobility is associated with significant short- and long-term morbidities in critically ill adults and children. The majority of critically ill children remain immobilized while in the pediatric intensive care unit (PICU) due to limited awareness of associated morbidities, lack of comfort and knowledge on how to mobilize critically ill children, and the lack of pediatric-specific practice guidelines. The objective of this article was to develop consensus practice recommendations for safe, early mobilization (EM) in critically ill children. A group of 10 multidisciplinary experts with clinical and methodological expertise in physical rehabilitation, EM, and pediatric critical care collaborated to develop these recommendations. First, a systematic review was conducted to evaluate existing evidence on EM in children. Using an iterative process, the working document was circulated electronically to panel members until the group reached consensus. The group agreed that the overall goals of mobilization are to reduce PICU morbidities and optimize recovery. EM should therefore not be instituted in isolation but as part of a rehabilitation care bundle. Mobilization should not be delayed, but its appropriateness and safety should be assessed early. Increasing levels of physical activity should be individualized for each patient with the goal of achieving the highest level of functional mobility that is developmentally appropriate, for increasing durations, daily. We developed a system-based set of clinical safety criteria and a checklist to ensure the safety of mobilization in critically ill children. Although there is a paucity of pediatric evidence on the efficacy of EM, there is ample evidence that prolonged bed rest is harmful and should be avoided. These EM practice recommendations were developed to educate clinicians, encourage safe practices, reduce PICU-acquired morbidities, until future pediatric research provides evidence on effective rehabilitation interventions and how best to implement these in critically ill children.

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Section: Rationalementioning

confidence: 89%

Practice Recommendations for Early Mobilization in Critically Ill Children

Choong

Canci

Clark

et al. 2017

J Pediatr Intensive Care

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“…Recent expert recommendations on safety criteria for early mobilization mentioned that vasopressor use [38, 39], endotracheal intubation, RRT [38], or even life support devices like ECMO [40] should not be considered as contraindications for active mobilization. Despite that, besides the study of Pohlman et al [32] performing in-bed mobilization with maximal FiO 2 at 1.0 and vasoactive drug, no study has explored the safety of very early mobilization in critically ill patients on multiple support systems.…”

Section: Discussionmentioning

confidence: 99%

Teamwork enables high level of early mobilization in critically ill patients

Hickmann

Castanares-Zapatero

Bialais

et al. 2016

Ann. Intensive Care

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BackgroundEarly mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients.ResultsGeneral practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15–23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients’ refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients’ subjective perception of physical therapy was reported to be enjoyable.ConclusionsMobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0184-y) contains supplementary material, which is available to authorized users.

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“…We retrieved a total of 1199 citations (after removal of 185 duplicates), of which, after title and abstract screening, 92 fulltexts articles were assessed, yielding 12 studies on mobilization in the PICU (Figure; available at www.jpeds.com) consisting of 1 clinical practice recommendation 19 and 11 individual studies. These 11 studies evaluated mobilization in a total of 1178 children with a range of medical-surgical and neurocritical care diagnoses, conducted across 3 different countries.…”

Section: Resultsmentioning

confidence: 99%

“…26 The wEECYCLE pilot RCT evaluated early mobilization practice guidelines as their standard of care, which recommended screening for appropriateness within 24 hours of PICU admission, and defined early as when contraindications are absent and a set of systems-based safety criteria are met. 19,20…”

Section: Mobility Interventions Timing and Definitions Of "Early"mentioning

confidence: 99%