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=11 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 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 was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.

Conclusions

Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.