Research Utilization Project: Early mobilization in pediatric cardiac surgical patients
Theodore R. Dage
University of Florida
Prolonged sedation and mechanical ventilation in the ICU setting has the potential for negative effects in the pediatric post-surgical period. A systematic review of the literature reveals a lack of high-quality recent research into the feasibility and benefits of an early mobilization protocol in this population. A PICO question will be stated to guide research, and an examination of the existing research on the subject discussed. The author will demonstrate the justification for further research into such a protocol.
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A PubMed search was performed using MeSH terms “cardiac surgery,” “early ambulation,” and “child.” This search resulted a single study regarding parental perceptions of fast-track cardiac surgery by Jawahar & Scarisbrick (2009). A revision of the PubMed search to include the term “fast-track” and delete “early ambulation” yielded 16 results, of which 7 were discarded for reasons including a focus on adult populations, a focus on parental perception, or a clinical focus on one specific intervention such as bispectral monitoring. The remaining articles range in date from 2000 to 2014, with the majority of studies conducted less than five years prior to this article.
A Cochrane database search was conducted utilizing the same MeSH terms as the PubMed search; there was no result returned. The search strategy was expanded to exclude the term “pediatric,” yielding a single meta-analysis by Zhu, Lee, & Chee (2012). While this review focuses on the adult cardiac patient, the fast-track strategies and discussion of adverse events associated with prolonged immobility and intubation may be generalizable to the pediatric population.
A comprehensive search of the AHRQ guideline database, guidelines.gov, in an effort to find evidence-based clinical practice guidelines for either early mobilization or fast track extubation; no such guidelines exist. A general database search in EBSCO provided a single UK guideline with tangential application to the research question. However, the majority of the guideline is dedicated to the discussion of sedation and analgesia in the critically ill child, and only indirectly discusses early extubation and mobilization (Playfor et al., 2006).
Given the articles found, there is reason to conclude that a knowledge gap exists in the discussion of mobilization of...