Early Mobilization in the Pediatric Intensive Care Unit

Abstract

Children admitted to intensive care units benefit essentially from chest physiotherapy (CP) and/or from postures. Mobilization does not seem to be a priority to unstable children: 9,5% of them benefit from early mobilization while 26% are mobilized later if CP prevails on mobilization. Predictive factors of early mobilization are: age, multiple organ failure, mechanical ventilation, sedation, vasopressor drugs, muscle blockers and winter season admission. The main institutional obstacles against mobilization are the lack of “rehabilitation” protocols and the mandatory medical prescription for the beginning of the treatment. The presence of an intubation catheter should not be an obstacle to early mobilization. Randomized controlled studies remain necessary to precise the feasibility, safety and benefits of early mobilization. If the interest of early mobilization cannot rely on large-scale studies, the results obtained are highly in favor of early motor, kinesthetic and postural management of the child for orality and postural torticollis. Recommendations about pediatric practices to follow during early mobilization are proposed in this review.