The PICU Up! Early Rehabilitation and Progressive Mobility Program was developed by pediatric critical care specialists at Johns Hopkins as a way to help reduce sedation and boost early mobility for children in an intensive care unit.
After testing the pilot program, investigators at the Johns Hopkins Children’s Center suggest that it is both safe and effective.
In addition, according to the investigators, the program resulted in increased rates of physical and occupational therapy consultations, from 54% to 66% and 44% to 5%, respectively, according to a media release from Johns Hopkins Medicine.
Their research was published recently in Pediatric Critical Care Medicine.
The PICU Up! program includes such activities as sitting at the edge of the bed, standing, moving from bed to chair, walking, and playing with toys. The activities are intended to “shift the culture” away from heavy sedation among children admitted to the pediatric intensive care unit, per the release.
“We’ve long underestimated what children in pediatric intensive care units (PICUs) can safely do,” says Sapna Kudchadkar, MD, assistant professor of anesthesiology and critical care medicine, director of the pediatric critical care clinical research program at the Johns Hopkins University School of Medicine and the study’s senior author, in the release.
“The prevailing belief is that children in the PICU should be heavily sedated to protect them from all of the stressors, such as the tubes, the strangers, and the physical pain. But fluctuating between a state of awareness and sedation can cause delirium, physical weakness, and post-traumatic stress disorder.”
In developing the program, Kudchadkar and her team first developed a three-level activity plan depending on each child’s physical limitations. Then, a working group of physicians, nurse practitioners, physical and occupational therapists, child life specialists, speech pathologists and others developed implementation guidelines and trained existing PICU staff members to use the program, which required no special equipment.
To test the program, during March through May 2015, the team recruited 100 children ages 1 day through 17 years admitted to the Johns Hopkins PICU for at least 3 days.
For a baseline comparison, the team first observed and recorded 465 mobilization activities in 100 patients; after implementation, they observed and recorded 769 mobilization activities.
Overall, the proportion of children receiving at least one in-bed activity increased from 70% to 98%, and the proportion of children who walked by day 3 increased from 15% to 2%. The median number of mobilizations per patient by day 3 in the PICU doubled from three to six.
Of the 39 orally intubated children, none walked prior to PICU Up! implementation, compared to four out of 40 orally intubated children who did so afterward, the release explains.
Kudchadkar notes in the release that her team’s findings demonstrate that “liberating” children in PICUs from heavy sedation as soon as possible and getting them moving earlier is possible and safe. However, she also acknowledges the challenge to conventional wisdom the new program poses.
“Mind-set more than manpower has been the biggest barrier to implementing the program here and is likely to be the same elsewhere. Once clinicians see how effective the program is and how positively it affects patients and families, change will come,” Kudchadkar states.
[Source(s): Johns Hopkins Medicine, Newswise]