Background

Immobility negatively affects muscle function, circadian rhythm, and potentially increases the risk of delirium. Early mobilization (EM) of critically ill adults has been found safe and effective.

Objectives

We evaluated the opinions and barriers of nurses and physicians to EM before and after implementation of an EM program.

Methods

A questionnaire was distributed to PICU nurses and physicians before (December 2017) and after (October 2018) implementation of an EM program. Descriptive statistics were used.

Results

Ninety-four (59.1%) and 71 (48.6%) members of the PICU staff completed the survey, respectively before and after implementation. During both periods, the general opinion was that early mobilization is beneficial for critically ill children. The largest perceived benefits were shorter durations of ventilation and PICU stay, lesser use of sedatives, and improved day-night cycle (80.3-100%) during both periods. Patients’ family satisfaction with EM had increased from 17% before to 32.4% after implementation. Before implementation, time constraint (64%), physiological instability (63%), risk of endotracheal tube dislocation (63%), loss of indwelling central venous catheter (60%), lack of equipment (53%), and increased workload (51%) were ranked as important barriers to EM. After implementation, only time constraint (73%), and risk of endotracheal tube dislocation (51%) were perceived as important barriers (p<0.001). Support of physical therapists for EM was perceived as significantly higher after implementation: 33% vs. 76% (p<0.001).

Conclusion

All nurses and physicians considered EM as important for critically ill children. Further, our research demonstrates that most of the perceived barriers had been resolved after implementation of EM.

Background

The Pediatric Early versus Late Parenteral Nutrition in Critical Illness (PEPaNIC) multicenter, randomized controlled trial (RCT) showed that withholding supplemental parenteral nutrition (PN) for up to one week in the pediatric intensive care unit (PICU) resulted in better outcomes [1,2] compared with initiating parenteral nutrition early on day one of admission to the PICU.

Objectives

This study investigates, two years after the PEPaNIC RCT, parent-reported Health-Related Quality of Life (HRQoL) of critically ill children compared with that of a healthy control group. Furthermore, effects of late-PN compared with early-PN during the first week in the PICU on long-term parent-reported HRQoL were examined. Parents’ own HRQoL was examined and was associated with the HRQoL they reported regarding their child.

Methods

All survivors of the 1440 children who participated in the RCT were approached for this 2-years follow-up. Patients were compared with 405 matched healthy children. Assessed outcomes comprised parent-reported HRQoL of the child and the parent. Measurements consisted of the parent-reported Infant Toddler Quality of Life Questionnaire (ITQOL, 0-3 years old), the parent-reported Child Health Questionnaire-Parent Form 50 (CHQ-PF50, 4-18 years old), and the parent-reported Health Utilities Index (HUI). For parents’ own HRQoL the self-reported Short Form Health Survey (SF-12) was used. To adjust for missing data, multiple data imputation by chained equations will be performed prior to univariable and multivariable linear and logistic regression analyses adjusted for risk factors.

Results

Analyses are planned at the end of January.

Conclusion

Conslusions will be presented at the conference.

Background

Almost no high quality randomized trials with relevant clinical outcomes in the field of nutrition in the PICU currently exist. An increasing amount of, mainly adult, critical care nutrition trials have shown us that nutritional interventions have clinical relevant impact on short- and long-term outcome. Interestingly, these findings from methodologically sound randomized controlled trials (RCTs) could often not confirm and even refuted observational, or intermediate outcome studies. This challenges us to define areas of research which have the highest priority. Timing, route and requirements still form the priorities for clinical research in pediatric critical care nutrition. A concept which is becoming more accepted is that these modalities are dynamic and change during time with the different phases of illness; acute, stable and recovering. Identifying clinical or metabol(om)ic biomarkers, to distinguish these different phases would pave the way forward towards major progress in optimizing nutritional therapy. The optimal dose of macronutrients during the course of illness remains one of the most challenging questions. In addition to caloric intake, the optimal timing and dose of proteins require an alternate perspective and more investigation on low, or even no protein intake during acute critical illness should be considered. Research in optimal nutritional strategy should also include the route of feeding. Based on observational studies ‘early’ enteral nutrition is feasible and should be pursued, although how this should be done remains an area of great uncertainty.

Objectives

Objectives

Methods

Methods Methods

Results

Results Results

Conclusion

Conclusion

Background

Immobility negatively affects muscle weakness, circadian rhythm, and potentially increases the risk of delirium. Providing early mobilization (EM) during the Intensive Care Unit (ICU) stay has shown effective in adults.

Objectives

We determined the feasibility and safety of the implementation of an EM program in a Pediatric ICU (PICU).

Methods

A prospective pre-posttest implementation study was conducted in patients admitted on a PICU for at least 3 days. This quality improvement project involved a usual care baseline phase, followed by a quality improvement phase implementing a multicomponent, multidisciplinary protocol for early mobilization of critically ill children. Primary outcome was the number of mobilization activities. Secondary outcomes were prevalence of delirium, consumption in sedatives, and mobilization related adverse events.

Results

In total, 61 children (pretest) and 56 children (posttest) were included, with a median age of 28 months (IQR 10-103) and 38.5 months (IQR 7-152), respectively. The median number of mobilization activities increased from 5 (IQR 3-7) to 6 (IQR 4-8) (p<0.0001). Among children who were ventilated, there was an increase in the proportion who participated in sitting in a chair: 27% vs. 54% (p<0.029). The delirium rate was not different between the pretest and posttest (15.3% vs. 14.0%; p=0.842). Further, there were no differences in median midazolam day doses (2.8 vs. 2.9 mg/kg; p=0.799) and morphine doses (0.18 vs. 0.22 mg/kg; p=0.797). No mobilization related adverse events were documented after implementation of the EM program.

Conclusion

Implementation of a structured EM program in PICU patients is feasible and resulted in no adverse events.

Background

Objectives

Methods

Results

Conclusion

Background

Almost no high quality randomized trials with relevant clinical outcomes in the field of nutrition in the PICU currently exist. An increasing amount of, mainly adult, critical care nutrition trials have shown us that nutritional interventions have clinical relevant impact on short- and long-term outcome. Interestingly, these findings from methodologically sound randomized controlled trials (RCTs) could often not confirm and even refuted observational, or intermediate outcome studies. This challenges us to define areas of research which have the highest priority. Timing, route and requirements still form the priorities for clinical research in pediatric critical care nutrition. A concept which is becoming more accepted is that these modalities are dynamic and change during time with the different phases of illness; acute, stable and recovering. Identifying clinical or metabol(om)ic biomarkers, to distinguish these different phases would pave the way forward towards major progress in optimizing nutritional therapy. The optimal dose of macronutrients during the course of illness remains one of the most challenging questions. In addition to caloric intake, the optimal timing and dose of proteins require an alternate perspective and more investigation on low, or even no protein intake during acute critical illness should be considered. Research in optimal nutritional strategy should also include the route of feeding. Based on observational studies ‘early’ enteral nutrition is feasible and should be pursued, although how this should be done remains an area of great uncertainty.

Objectives

Objectives

Methods

Methods Methods

Results

Results Results

Conclusion

Conclusion

Background

Objectives

Methods

Results

Conclusion