Abstract
The objective of this study was to evaluate the feasibility and safety of implementing
two methods of in-bed mobilization in critically ill children. This prospective cohort
trial was conducted at McMaster Children's Hospital, Pediatric Critical Care Unit
(PCCU). Hemodynamically stable patients aged 3 to 17 years with a longer than 24-hour
PCCU stay were eligible to participate in the study. Children with cardiorespiratory
instability, already mobilizing well or at their baseline mobility, anticipated death
during this PCCU admission, and those with contraindications to mobilization were
excluded. Two methods of mobilization were applied for a maximum of 2 days, respectively,
depending on the level of consciousness and cognitive ability of the participant.
In-bed cycling was used for passive mobilization and interactive video games (VG)
were used for active mobilization. The primary outcomes were safety and feasibility.
Secondary outcomes were physical activity during the study period, as reflected by
accelerometer measurements. A total of 406 patients were screened over 1 year, 35
of who were eligible and 31 (89%) consented to participate. Median age of participants
was 11 years (quartile 1 is 6 years and quartile 3 is 14 years), and 15 (48%) were
male. Twenty-five (81%) participants received the study intervention, 22 (88%) of
who received the intervention within 24 hours of consent. Twenty-one (84%) participants
received in-bed cycling, five (20%) received VG, and only one received both. Fifteen
(60%) completed the prescribed 2-day intervention, while in 11 (44%) the intervention
was interrupted or not applied, most commonly because the patient was transferred
out of the PCCU. Physical activity was greater during the intervention compared with
nonintervention times with in-bed cycling, but not with VG. There were no adverse
events attributable to the intervention. This pilot reveals that in-bed cycling can
enhance physical activity, and appears to be safe and feasible in this group of critically
ill children. VG was feasible only in a minority of patients who were cooperative
and age appropriate. Further research is necessary to evaluate the efficacy and most
appropriate methods of enhancing mobility and rehabilitation in this population.
Keywords
critical care - pediatrics - mobilization - rehabilitation - interactive video game
- cycle ergometry - feasibility - safety
