A perspective on early mobilization for adult patients with respiratory failure: Lessons for the pediatric population

Article type: Research Article

Authors: Munkwitz, Michele | Hopkins, Ramona O.^; | Miller III, Russell R.^; | Luckett, Peter M | Hirshberg, Eliotte L.^{; ;}

Affiliations: Department of Pediatrics, Pediatric Critical Care, University of Utah, Primary Children's Medical Center, Salt Lake City, UT, USA | Department of Medicine, Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA | Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA | Department of Internal Medicine, Division of Pulmonary Rehabilitation and Critical Care Medicine, Salt Lake City, UT, USA | Department of Pediatrics, UT Southwestern Medical Center, Pediatric Pulmonary and Critical Care Medicine, Children's Medical Center Dallas, Dallas, TX, USA

Note: [] Corresponding author: Ellie Hirshberg, MD-5121 South Cottonwood Street, Murray, UT 84107, USA. Tel.: +1 801 507 6556; Fax: +1 801 507 5578; E-mail: [email protected]

Abstract: Objective: To summarize the evidence for early mobilization programs in critically ill pediatric and adult patients with respiratory failure. This paper describes our review of the literature and outlines the morbidities associated with immobility, mechanical ventilation and sedation.The clinical management of acutely ill pediatric patients with respiratory failure traditionally consists of mechanical ventilation, sedation and prolonged immobilization. Although the most severely ill patients require these therapies for survival, each therapy comes with adverse consequences. Early mobilization may reduce complications and confer benefit for children with respiratory failure or those who require prolonged mechanical ventilator support. Design: Systematic review of the literature pertaining to early mobilization in pediatric and adult patients with respiratory failure. We searched Medline, PubMed, CINAHL and Cochrane database of controlled trials. Randomized controlled trials (RCTs), observational cohort studies, case control studies and population-based analysis were considered for inclusion. Two reviewers (MM and EH) independently selected pertinent studies. Results: No studies of early mobilization in pediatric populations were found. Five adult studies were identified for review; two randomized controlled trials and three observational studies. All studies suggested an improvement in morbidity and economic benefit with implementation of early mobilization. Conclusions: Early mobilization in critically ill adult patients with respiratory failure is associated with a decrease in duration of sedatives, ventilator dependant days, ICU and hospital length of stay. The paucity of studies of early mobilization suggest that implementation of early mobilization is not widely practiced. Studies of early mobilization therapy in the adult patient requiring prolonged mechanical ventilator support are reviewed, and the physiologic rational and observed obstacles to integration of an early mobilization program are discussed. The adult data and scientific evidence are combined to support an opinion about the possible benefits of early mobilization programs. The generalizability of the findings and the feasibility of implementing early mobilization in critically ill children who require prolonged mechanical ventilator support are also considered.

Keywords: Mechanical ventilation, immobility, mobility, inflammation, critical illness neuromuscular injury, sedation, pediatrics\vspace{-1.2cm}

DOI: 10.3233/PRM-2010-0130

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 3, no. 3, pp. 215-227, 2010