(849) Exploring the Impact of Early Mobilization in the Pediatric Cardiac Intensive Care Unit

Introduction: Early mobilization (EM) is defined as physical therapy within 48-72 hours of admission. EM has proven benefits in adults at and after discharge. Pediatric data is focused on the safety and feasibility of EM, with limited evidence on outcomes. The purpose of this study was to explore the feasibility of frailty measures in pediatric cardiac surgical patients to characterize the impact of EM on functional status in this population.

Methods: We performed a single-center, prospective feasibility cohort study including patients ≥5 years old admitted post-operatively to the pediatric cardiac intensive care unit (PCICU). Our primary outcome was muscle strength at discharge, assessed via grip strength. Secondary outcomes included patient anxiety (Exercise Sensitivity Questionnaire, ESQ), depression (PHQ-9), quality of life (pedsQL v4), and time until return to normal activity.

Results: We have approached 21 potential participants. Of these, 7 have agreed to participate. Reasons for declining participation included pain, lack of interest, and wish to focus on recovery. 75% of patients who declined participation received EM vs 100% of those who consented to the study. The median age of the 7 participants was 12 years (IQR 6-20). Two patients (25%) required invasive mechanical ventilation (IMV) at the time of ICU admission. Median ICU length of stay (LOS) was 25 hours (IQR 23.7-32.8) and hospital LOS was 4 days (IQR 1-7). One patient (14%) had EM within 24 hours, 5 patients (72%) within 48 hours of ICU admission. Six patients completed muscle strength testing at discharge with a median grip strength of 9.3 kg (IQR 7.1-11.8). All patients completed QOL testing (median 34, IQR 18-35.5). All eligible patients (≥12 years) completed anxiety and depression scales. Median ESQ was 45 (IQR 41.5-47.3). Median PHQ-9 was 7.5 (IQR 5.5-11.5), consistent with mild depressive symptoms. One month follow up data is available for 5 patients. All endorsed return to normal functioning.

Conclusions: Use of frailty and patient centered measures appears to be a feasible way to explore outcomes in this cohort. Many patients endorsed functional disturbances at the time of discharge. We hope to continue this research to evaluate the possible impact of EM on strength and emotional functioning in this unique population.