(848) Evaluating Barriers to Early Mobilization in the Pediatric Cardiac Intensive Care Unit

Introduction: Early mobilization (EM) is defined as physical therapy (PT) within 48-72 hours of admission. Although EM benefits critically ill adults, only 25-50% of eligible patients receive it. Reports of EM in children are limited. We sought to characterize EM in the PICU, and identify potential barriers to receiving this therapy. Based on prior literature, we hypothesized that fewer than 75% of eligible children received EM.

Methods: We performed a single-center study from 1/1/2022 to 11/1/2023. All data were abstracted from the EHR retrospectively. Patients who remained in the hospital for at least 72 hours after PICU admission were included. Analysis was stratified at the unit level: cardiothoracic (PCICU), medical/surgical (MSPICU), neurological (NPICU). The primary outcome was receipt of EM, defined as PT within 72 hours of admission. Unit type, potential covariates, and secondary outcomes were examined via bivariate tests and measures of association.

Results: Among 2182 patients, 1705 met inclusion criteria. Of these, 590 (34.6%) were admitted to the PCICU, 471 (27.6%) MSPICU, and 644 (37.8%) NPICU. EM was received by 837 (49%) patients. PT orders were placed within 72 hours for 74% of patients, and more frequently within the NPICU and PCICU compared to the MSPICU (77% vs 76% vs 68%, p< 0.001). Patients who received EM were more likely to be admitted to the NPICU vs. PCICU or MSPICU (45% vs 32% vs 23%, p< 0.0001). Patients requiring invasive mechanical ventilation (IMV) within the first 24 hours were less likely to receive EM (RR 0.59, p< 0.001). Patients in the EM group had shorter duration of chest tubes (2.9 vs 4.6 days, p< 0.001), ICU length of stay (LOS) (3 vs 4.7 days, p< 0.0001), and hospital LOS (7.5 vs 10 days, p< 0.0001).

Conclusions: Fewer than half of PICU patients received EM. Both patient and structural factors appear associated with receiving EM, such as order placement, requiring IMV, and type of PICU. Potentially modifiable structural factors such as PT availability, ability to deliver PT during IMV, and organization of care in different PICU models should be further studied.