Authors (including presenting author) :
PAK CH(1), HUI WF(2), HO YB(1), CHAN NC(1),YB HON KL(2)
Affiliation :
(1)Allied Health Department (Physiotherapy), (2)Department of Pediatrics and Adolescent Medicine, Hong Kong Children’s Hospital
Introduction :
Traditionally, bedrest was often instructed during continuous renal replacement therapy (CRRT) in Paediatric Intensive Care Unit (PICU). Prolonged immobilization may increase the risk of development of deep vein thrombosis and other complications delaying recovery. In addition, play activities are essential and also beneficial to the paediatric patients’ physical and mental development. Physiotherapists collaborated with the PICU team to provide structured early mobilization and rehabilitation program which is safe, feasible and fun to the paediatric patients.
Objectives :
This case report aims to evaluate the effectiveness of the early mobilization and rehabilitation program for a PICU patient receiving CRRT.
Methodology :
It is a case report. The medical and physiotherapy records were reviewed for a 7-year-old boy with hepatoblastoma and lung metastasis during his PICU stay. Physiotherapists teamed up with the PICU team for a safe early mobilization and rehabilitation program. The outcome measures include 1) Maximum Inspiratory and Expiratory Pressures (MIP & MEP), 2) Children’s Chelsea Critical Care Physical Assessment Tool (cCPAx), and 3) record of any adverse event.
Result & Outcome :
The patient required invasive ventilatory support and CRRT on PICU admission. During the intubation phase, chest physiotherapy, inspiratory muscle training and early bedside mobilization incorporated with active video gaming training (AVG) were carried out. The strategies to enhance the safety of out-of-bed rehabilitation were discussed in the weekly co-joint Allied Health Round. In a team approach, out-of-bed rehabilitation was incorporated with AVG successfully processed on day 10 while the patient was still receiving CRRT during his intubation phase. The ventilatory weaning was achieved on day 18 of PICU stay. Improved MIP/MEP measurements of 31/33cmH2O was obtained on day 20 in comparison to the measurements of 20/20cmH2O during early phase of intubation. In addition, assisted walking and tricycling after his extubation had been carried out since day 18. Overall cCPAX score was improved from 2/50 on day 1 to 35/50 on day 45. There was no adverse event reported during the entire review period. PICU multidisciplinary collaboration accounts for the success of early mobilization and rehabilitation for a critically ill patient during CRRT. This catalyzes the development of a systematic protocol for the early mobilization and rehabilitation program in PICU in the future.
