Early Mobilization after Pediatric Liver Transplantation

Abstract

Objective This study aims to evaluate the impact of early mobilization (EM) after pediatric liver transplantation in the pediatric intensive care unit (PICU).

Design A 14-month prospective before and after study.

Setting Multivalent PICU with 20 beds at a tertiary children's hospital.

Patients A total of 57 patients aged younger than 16 years who received liver transplantation and were admitted to the PICU after surgery.

Interventions EM project, a multifaceted framework for successful EM practice in the PICU focusing on a multidisciplinary team approach.

Measurements and Main Results Compared with the period before the implementation of the EM project, there was a significant increase in the proportion of patients who received physical therapy in the PICU (43 vs. 97%, p < 0.001). Also, there were greater median numbers of physical therapy per eligible patient (0 vs. 3, p < 0.001). Moreover, patients achieved higher functional mobility level within a shorter time. Length of intubation, PICU stay, and hospital stay were not significantly different. There were no adverse events or deaths.

Conclusion Using an EM project process, the proportion of patients who received physical therapy after liver transplantation increased. However, there was no difference in the length of PICU or hospital stay. Our findings indicated that EM for pediatric patients who received liver transplantation was well tolerated and safe.

Keywords

early mobilization - rehabilitation - pediatric intensive care unit - physical therapy

Note

The authors Norihiko Tsuboi and Mureo Kasahara have received the grant from National Center for Child Health and Development (no. 27–1). For the remaining authors none were declared.

• References

• 1 Needham DM, Korupolu R, Zanni JM. , et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010; 91 (04) 536-542
• 2 Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 2013; 41 (06) 1543-1554
• 3 Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest 2013; 144 (03) 825-847
• 4 Cameron S, Ball I, Cepinskas G. , et al. Early mobilization in the critical care unit: A review of adult and pediatric literature. J Crit Care 2015; 30 (04) 664-672
• 5 Schweickert WD, Pohlman MC, Pohlman AS. , et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373 (9678): 1874-1882
• 6 Morris PE, Goad A, Thompson C. , et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008; 36 (08) 2238-2243
• 7 Bakhru RN, Wiebe DJ, McWilliams DJ, Spuhler VJ, Schweickert WD. An Environmental Scan for Early Mobilization Practices in U.S. ICUs. Crit Care Med 2015; 43 (11) 2360-2369
• 8 Wieczorek B, Burke C, Al-Harbi A, Kudchadkar SR. Early mobilization in the pediatric intensive care unit: a systematic review. J Pediatr Intensive Care 2015; 2015 (15) 129-170
• 9 Choong K, Koo KK, Clark H. , et al. Early mobilization in critically ill children: a survey of Canadian practice. Crit Care Med 2013; 41 (07) 1745-1753
• 10 Melnyk BM, Alpert-Gillis L, Feinstein NF. , et al. Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 2004; 113 (06) e597-e607
• 11 Taylor A, Butt W, Ciardulli M. The functional outcome and quality of life of children after admission to an intensive care unit. Intensive Care Med 2003; 29 (05) 795-800
• 12 Ely EW, Truman B, Shintani A. , et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003; 289 (22) 2983-2991
• 13 Kelly B, Englesbe M, Bucuvalas J. , et al. Improving value after pediatric liver transplant: discharge practices of high-performing centers [abstract]. Am J Transplant 2013; 13 (Suppl. 05) 47
• 14 Sricharoenchai T, Parker AM, Zanni JM, Nelliot A, Dinglas VD, Needham DM. Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation of 1110 intensive care unit admissions. J Crit Care 2014; 29 (03) 395-400
• 15 Zanni JM, Korupolu R, Fan E. , et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care 2010; 25 (02) 254-262
• 16 Bourdin G, Barbier J, Burle JF. , et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care 2010; 55 (04) 400-407
• 17 Lee H, Ko YJ, Suh GY. , et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care 2015; 30 (04) 673-677
• 18 Hodgson CL, Stiller K, Needham DM. , et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014; 18 (06) 658