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New PICU protocol gets young patients up and moving

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Early mobility for young ICU patients improves outcomes, decreases length of stay.

Early mobility program improves the culture of mobility for critically ill children

Two years ago, Sapna Kudchadkar was eager to discover if safely increasing a young patient’s passive or active activity level within the first 3 days of critical illness would maintain or restore musculoskeletal strength and function, lower the rates of immobility-associated complications, and generally improve patient outcomes.

From years of attending in the Johns Hopkins PICU, she was well aware of the culture of immobility that kept young patients immobilized and sedated to allow them to rest and to ease their pain and suffering. The problem with this long-standing practice is that it too often leaves patients, who will recover, physiologically dependent on opioids and benzodiazepines. They tend to have disturbed sleep, increased delirium and physical atrophy. And for patients who will not recover, this long-standing practice too often robs them and their loved ones of quality time at the end of life.

Dr. Kudchadkar wanted to promote a culture of mobility among all the Johns Hopkins PICU staff. She believed that a standardized, evidence-based, interdisciplinary early mobilization protocol in her PICU—similar to the one being used for many years in the Johns Hopkins adult ICU—was both feasible and safe.

The result of her study and implementation: PICU Up! demonstrated that a bundled intervention to create a healing environment in the PICU with structured activity is safe, feasible, and may have benefits for short- and long-term outcomes of critically ill children.

We will post here this Fall the results of the research conducted by Dr. Kudchadkar and her colleagues at Johns Hopkins and the University of Maryland School of Nursing: “PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Rehabilitation and Progressive Mobilization in Critically Ill Children.”

Click here to see Dr. Sapna Kudchadkar talk about this innovative PICU protocol.