Early mobilization protocols for critically ill pediatric patients: systematic review

OBJETIVO: Descrever os protocolos existentes de mobilizacao precoce nas unidades de terapia intensiva pediatrica. METHODS: A systematic literature review was performed using the databases MEDLINE®, Embase, SciELO, LILACS and PeDRO, without restrictions of date and language. Observational and randomized and nonrandomized clinical trials that described an early mobilization program in patients aged between 29 days and 18 years admitted to the pediatric intensive care unit were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale, Methodological Index for Non-Randomized Studies and the Cochrane Collaboration. RESULTS: A total of 8,663 studies were identified, of which 6 were included in this review. Three studies described the implementation of an early mobilization program, including activities such as progressive passive mobilization, positioning, and discussion of mobilization goals with the team, in addition to contraindications and interruption criteria. Cycle ergometer and virtual reality games were also used as resources for mobilization. Four studies considered the importance of the participation of the multidisciplinary team in the implementation of early mobilization protocols. CONCLUSAO: De modo geral, os protocolos de mobilizacao precoce sao baseados em intervencoes individualizadas, conforme o desenvolvimento da crianca. Alem disso, o uso do cicloergometro pode ser viavel e seguro nesta populacao. A implementacao de protocolos institucionais e multiprofissional pode contribuir para a pratica da mobilizacao precoce nas unidades de terapia intensiva pediatrica, no entanto sao necessarios estudos que comprovem a eficacia da intervencao.