https://www.ncbi.nlm.nih.gov/pubmed/30489487 Liver transplant

Pediatr Crit Care Med. 2018 Nov 26. doi: 10.1097/PCC.0000000000001815. [Epub ahead of print]
Benefits of Early Mobilization After Pediatric Liver Transplantation.
Tsuboi N1, Hiratsuka M1, Kaneko S1, Nishimura N1, Nakagawa S1, Kasahara M2, Kamikubo T3.

Abstract

OBJECTIVE:
To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU.

DESIGN:
A 70-month retrospective before-after study.

SETTING:
Medical and surgical PICU with 20 beds at a tertiary children's hospital.

PATIENTS:
Seventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery.

INTERVENTION:
We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach.

MEASUREMENTS AND MAIN RESULTS:
There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0-10.6 min] vs 17.4 min [13.2-26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16-66] vs 23 [19-31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37-99] vs 40 [31-54] postoperative days; p = 0.012).

CONCLUSIONS:
Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.