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La mobilisation précoce en réanimation pédiatrique

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Moerman, Damien [UCL] Houtekie, Laurent [UCL]

(fre) Les enfants admis en réanimation bénéficient essentiellement de traitements de kinésithérapie respiratoire (KR) et/ou de postures. La mobilisation n’apparaît pas être une priorité chez les enfants instables : 9,5 % d’entre eux sont mobilisés précocement et 26 % sont mobilisés plus tardivement si la séance de KR prévaut sur la mobilisation. Les facteurs prédictifs d’une mobilisation précoce sont l’âge des patients, la défaillance multiviscérale, la présence d’une ventilation mécanique ou d’une sédation, l’administration de vasopresseurs ou de bloquants neuromusculaires et l’ad- mission pendant les mois d’hiver. Les principaux obstacles institutionnels à la mobilisation sont le manque de protocole et l’absence de prescription médicale pour débuter le traite- ment. La présence d’une sonde d’intubation ne devrait pas être un frein à la mobilisation précoce. Des études randomi- sées contrôlées restent nécessaires pour en comprendre la faisabilité, la sécurité et les bénéfices. Si l’intérêt de la mobilisation précoce ne peut s’appuyer sur des études de grande ampleur, les résultats obtenus pour l’oralité et le tor- ticolis postural sont très en faveur d’une prise en charge précoce motrice, kinesthésique et posturale de l’enfant. Des recommandations sur les pratiques pédiatriques à sui- vre lors de mobilisation précoce sont ainsi proposées dans cet article.

(eng) [Early mobilization in the pediatric intensive care unit] Children admitted to the pediatric intensive care unit (PICU) can experience significant morbidity as a consequence of mechanical ventilation and sedative medications. This morbidity could potentially be decreased with the implementation of activities to promote early mobilization during critical illness. The objective of this systematic review is to summarize the current evidence regarding rehabilitation therapies in the PICU and to highlight the knowledge gaps and avenues for future research on early mobilization in the PICU. Using a combination of controlled vocabulary and key word terms PubMed, CINAHL, and EMBASE databases were searched; no limiters were imposed on search strategies. Two reviewers abstracted data and assessed quality independently. From the 1928 articles identified in the search 168 abstracts were identified for full text review. Fifty-nine articles were chosen for data extraction and five were identified for inclusion in review. A sixth article was identified through expert clinician query. The studies were categorized into three groups based on the outcomes discussed: safety and feasibility, functional outcomes, and length of stay. A synthesis of the studies indicates that early rehabilitation in the PICU is safe and feasible with potential short and long-term benefits. Institutional, provider and patient-related barriers to initiation of early rehabilitation in the PICU are identified. Recommendations for future investigation include early rehabilitation protocols for children hospitalized in the PICU and identification of outcome measures.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès interdit
Publication date 2016
Language Français
Journal information "Médecine Intensive Réanimation" - Vol. 25, no. 5, p. 542-548 (2016)
Peer reviewed yes
Publisher Springer ((France) Paris)
issn 2496-6142
e-issn 1951-6959
Publication status Publié
Affiliations UCL - (SLuc) Service de médecine physique et de réadaptation motrice
UCL - (SLuc) Service de soins intensifs
Keywords Children ; Early rehabilitation ; Infants ; Mobilization ; Paediatric intensive care
Links
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Bibliographic reference Moerman, Damien ; Houtekie, Laurent. La mobilisation précoce en réanimation pédiatrique. In: Médecine Intensive Réanimation, Vol. 25, no. 5, p. 542-548 (2016)
Permanent URL http://hdl.handle.net/2078.1/174891