AUTHOR=Ghafoor Saad , Fan Kimberly , Williams Sarah , Brown Amanda , Bowman Sarah , Pettit Kenneth L. , Gorantla Shilpa , Quillivan Rebecca , Schwartzberg Sarah , Curry Amanda , Parkhurst Lucy , James Marshay , Smith Jennifer , Canavera Kristin , Elliott Andrew , Frett Michael , Trone Deni , Butrum-Sullivan Jacqueline , Barger Cynthia , Lorino Mary , Mazur Jennifer , Dodson Mandi , Melancon Morgan , Hall Leigh Anne , Rains Jason , Avent Yvonne , Burlison Jonathan , Wang Fang , Pan Haitao , Lenk Mary Anne , Morrison R. Ray , Kudchadkar Sapna R. 

TITLE=Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.645716

DOI=10.3389/fonc.2021.645716

ISSN=2234-943X

ABSTRACT=Introduction: Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods: We describe the development and feasibility of implementing an early mobility quality improvement initiative (BRAVE) in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results: Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25% to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of  admission to the intensive care unit from 21% to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43% to 37% (p=0.46). The early mobility initiative did not cause a significant increase in unplanned extubations, lead to the unintentional removal of central venous catheters, or cause injury to patient or staff. Conclusions: Our experience supports the safety and efficacy of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.