Bryant Gamboa
Nurse
Loma Linda University Children's Hospital
Loma Linda, California
Disclosure information not submitted.
Michele Wilson, MS, RN, NP, CCNS, CCRN-K
PICU & Peds Step Down ICU Clinical Nurse Specialist
Loma Linda University Children's Hospital, United States
Disclosure information not submitted.
Harsha Chandnani, MBA, MD, MPH
Assistant Professor of Pediatrics
Loma Linda University, United States
Disclosure information not submitted.
Kristin Diaz, MSN, RN, CCRN
Executive Director, Patient Care Services
Loma Linda University Children's Hospital, California, United States
Disclosure information not submitted.
Alison Bennett, DNP, CPNP-PC, CNS, RN
DNP
Loma Linda University, United States
Disclosure information not submitted.
.jpg "Merrick Lopez, MD photo")
Title: Introducing an Early Mobilization Protocol of Ventilated Infants in a Pediatric ICU
Introduction: Progressive mobility has been shown to prevent neuromuscular degeneration and improve patient outcomes by decreasing ventilator days, hospital lengths of stay, and costs. Our Pediatric Intensive Care Unit (PICU) did not have a standardized practice of mobilizing ventilated patients. Implementing holding practices may be a form of progressive mobilization for infants and young children. The goal of this study is to implement an early mobilization (EM) protocol for intubated infants and describe observed physiologic effects.
Methods: This pilot study was implemented in a 25-bed PICU at a tertiary care hospital. Staff (nurses, physicians, respiratory therapists, and pharmacists) were given pre- and post-implementation surveys to assess their perceived beliefs, barriers, and attitudes towards EM of intubated patients. Education on the protocol methods, and EM benefits and safety was shared. The protocol was implemented over 45 days in March 2021. Data collection included vital signs prior to mobilization events and prior to transferring back to cribs. Parental surveys were collected after the initial mobilization event.
Results: A total of 26 mobilization events were observed among 8 mechanically-ventilated infants. Pre- and post-implementation surveys demonstrated that concern for patient safety was the highest perceived barrier among staff. This concern decreased by 24% post-implementation. Concerns for insufficient staff and time increased after implementation. Additionally, statistically significant decreases in heart rate and respiratory rate were noted during EM and holding. No adverse events (i.e., unplanned extubations, catheter dislodgments) were reported. All parents (n=8) believed they were a valuable part of the healthcare team and perceived that EM positively impacted their infant, was done in a safe manner, and helped their infant relax.
Conclusions: Implementation of a protocol that standardized EM of ventilated infants demonstrated statistically significant decreases in physiologic parameters with mobilization events without adverse events. This project demonstrated that EM of ventilated infants can be done in a safe manner with benefits for both the patient and family.