Royal Hospital, Oman
Title: Early mobilization in Critically ill children
Saif Awlad thani is a pediatric Intensivist from Sultanate of Oman. He finished his medical school in Sultan Qaboos University and pediatric residency in Oman Medical Specialty board in Oman. He finished his PICU fellowship in McMaster university in Canada. Currently he is working in a tertiary hospital in Oman and acting as deputy director of cardiac ICU. He is the founder and leader of pediatric home ventilation team. He is interested in improving quality of care and PICU patient’s outcome. He participated in pilot RCT and qualitative study about early mobilization in critically ill children. He is interested in research and education and working in many research project and coordinating PICU teaching for PICU residents.
Patients are often confined to bed rest for prolonged periods of time as they are perceived to be “too sick” to be mobilized (1). However, multiple adverse physical, neuromuscular, metabolic, and cognitive sequelae of immobility during critical illness are increasingly recognized (2). Survivors of critical illness are at risk of prolonged weakness, functional disability, and delayed recovery, resulting in suboptimal quality-of-life and high healthcare utilization costs (3-4. Prolonged immobility increases the risk of critical illness-acquired morbidities such as ICU-acquired weakness, delirium and sedation withdrawal, which in turn negatively impact on a patient’s duration of mechanical ventilatory support, length of stay, and even mortality (6). A lot of clinicians are reluctant to mobilize critically sick children due to various factors including but not limited to: lack of knowledge of mobility importance, unawareness of current evidence, safety issue, lack of personnel and limited equipment and fear of adverse events (7). Current evidence suggests that early mobility-based rehabilitation in critically ill patients can attenuate the complications of immobility and critical illness-acquired morbidities (8). Early mobilization (EM) may reduce the risk of delirium, improve functional recovery, and reduce overall resource utilization in (7). There are various modes of mobilization in critically ill children that varies according to age, baseline functional and cognitive status and clinical condition of the child. Therefor degree of mobilization should be individualized and developmentally appropriate in order to be successful, effusive and safe (8).We published recently an RCT pilot study evaluation feasibility of in-bed mobilization by cycle ergometer in addition to usual care physiotherapy to enhance early mobilization and we found safe with no adverse events that tell us the early mobilization can be achieved by different way and by new technology (9)