Medical Equipment Reduces Out-of-Bed Mobility for Critically Ill Children

Introduction: Early mobility is an important strategy to reduce immobility-associated morbidity for children in pediatric intensive care units (PICUs). Medical equipment has been identified as a barrier to early mobility. We aimed to determine the impact of medical equipment on out-of-bed mobility for critically ill children.


Methods: We conducted a secondary analysis of the PICU Up! multicenter stepped-wedge cluster randomized controlled trial pilot study, which is a study of an early mobility intervention conducted in seven PICUs in the United States. Patients were followed for the duration of their PICU hospitalization once enrolled. Mixed effect logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between out-of-bed mobility and medical equipment. All models were adjusted for pre-defined covariates.


Results: Mobility data were compiled from 28,039 patient-days from 2363 individual patients. Overall, 32% of all patient-days (9092/28039) included out-of-bed mobility and 75% of all patient-days (21182/28039) included medical equipment. Of patient-days where a child was mobilized out-of-bed, 64% (5785/9092) had medical equipment with a median of one piece of medical equipment. Of patient-days where a child was not mobilized out-of-bed, 82% (15050/18436) had medical equipment with a median of two pieces of medical equipment. Adjusted for covariates, the odds of out-of-bed mobility per each medical equipment was 0.69 (95% CI 0.6-0.81). Other factors associated with decreased out-of-bed mobility included sedative infusions (aOR 0.37; 95% CI 0.26-0.51), non-invasive positive pressure (aOR 0.52; 95% CI 0.34-0.78), mechanical ventilation via endotracheal tube (aOR 0.13; 95% CI 0.08-0.21), mechanical ventilation via tracheostomy (aOR 0.37; 95% CI 0.19-0.71), and screening positive for delirium (aOR 0.64; 95% CI 0.48-0.85). Illness severity did not impact the likelihood of out-of-bed mobility.


Conclusions: An increase in the number of medical devices decreased the likelihood that a critically ill child was mobilized out-of-bed, regardless of illness severity. Further education is required to increase the interprofessional team’s confidence and skills mobilizing critically ill children with multiple medical devices.