Early Mobilization in Pediatric Intensive Care Unit

Year 2024, Volume: 2 Issue: 2, 141 - 154, 30.10.2024

Döne Aksu Deniz

Abstract

ABSTRACT
Children admitted to the pediatric intensive care unit remain immobile for long periods of time for various reasons and struggle with permanent problems that affect life even after discharge. Due to these negative outcomes, rehabilitation and early mobilization of patients during the intensive care period have gained importance. Mobilization activities are carried out in a planned manner by creating an interdisciplinary, nurse-focused protocol with the cooperation of the physician, physiotherapist, pediatric occupational therapist and family. The early mobilization protocol is a gradual system in which the patient's sleep hygiene, pain, delirium and sedation are evaluated and individualized mobilization goals specific to the patient are determined. Various mobilization activities such as in-bed active and passive Range of motion exercises, sitting on the edge of the bed, throwing a ball, in-bed bicycle ergometry, and walking are planned according to the clinical condition and tolerance of the patient. In clinical studies, it has been reported that with the use of early mobilization protocol, the number of patients and mobilization activities increased, the length of hospital stay of patients decreased, daily living activities improved, and morbidities acquired in intensive care decreased. Nurses can easily integrate mobilization activities into daily care because they are with the patient all day. Current studies show that early mobilization activities are feasible and safe in critically ill pediatric patients. Furthermore, the lack of a standard mobilization protocol in pediatric intensive care units, lack of information, safety concerns, and inadequate equipment and personnel are barriers to the implementation of early mobilization. In this review, the definition and importance of early mobilization, examples of application in pediatric intensive care and the results of current clinical studies are discussed.

Keywords

Pediatric intensive care unit, Early mobilization, Nursing, Rehabilitation, Pediatric patient

Çocuk Yoğun Bakımda Erken Mobilizasyon

Abstract

ÖZET
Çocuk yoğun bakım ünitesine yatırılan çocuklar çeşitli nedenlerle uzun süre hareketsiz kalmakta ve taburcu olduktan sonra bile hayatı etkileyen kalıcı sorunlarla mücadele etmektedir. Bu olumsuz sonuçlardan dolayı hastaların yoğun bakım sürecinde rehabilitasyonu ve erken mobilizasyonu önem kazanmıştır. Mobilizasyon aktiviteleri hekim, fizyoterapist, pediatrik ergoterapist, aile işbirliği ile disiplinler arası, hemşire odaklı bir protokol oluşturularak planlı yürütülmektedir. Erken mobilizasyon protokolü hastanın uyku hijyeni, ağrı, deliryum ve sedasyon değerlendirmelerinin yapıldığı, hastaya özgü bireyselleştirilmiş mobilizasyon hedeflerinin belirlendiği kademeli bir sistemdir. Yatak içi aktif ve pasif Range of motion egzersizleri, yatak kenarında oturma, top fırlatma, yatak içi bisiklet ergometrisi, yürüme gibi çeşitli mobilizasyon aktiviteleri hastanın klinik durumu ve toleransına göre planlanmaktadır. Yapılan klinik çalışmalarda erken mobilizasyon protokolü kullanımı ile mobilizasyon aktivitelerinin uygulandığı hasta ve mobilizasyon aktivitesi sayısının arttığı, hastaların hastanede kalış süresinin azaldığı, günlük yaşam aktivitelerinin iyileştiği ve yoğun bakımda edinilen morbiditelerin azaldığı bildirilmiştir. Hemşireler tüm gün yanında olduğu için mobilizasyon aktivitelerini günlük bakıma kolaylıkla entegre edebilir. Güncel çalışmalar erken mobilizasyon aktivitelerinin kritik çocuk hastalarda uygulanabilir ve güvenli olduğunu göstermektedir. Ancak çocuk yoğun bakım ünitelerinde standart bir mobilizasyon protokolünün olmaması, bilgi eksikliği, güvenlik endişeleri, ekipman ve personel yetersizliği erken mobilizasyonun uygulanmasının önünde engellerdir. Bu derlemede erken mobilizasyonun tanımı ve önemi, çocuk yoğun bakımda uygulama örnekleri ve güncel klinik çalışmaların sonuçlarına yer verilmiştir.

Keywords

Çocuk yoğun bakım, Erken mobilizasyon, Hemşirelik, Rehabilitasyon, Çocuk hasta

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