Initial Findings of the Effects of Early Mobilization on Inflammatory Cytokines in Critically Ill Pediatric Patients: A Pilot Study

Background: Early mobilization of critically ill patients has been linked to shorter hospital length of stay, less days on a ventilator and less days in the ICU. There are some small adult studies indicating that decreased inflammation secondary to early mobilization may be linked to shorter length of stay. The majority of pediatric early mobility literature focuses on safety and feasibility along with outcome measures such as length of stay, with no literature currently examining potential mechanisms. The implementation of an early mobility program- entitled the ‘Let’s Move’ initiative- in our pediatric ICU began in Fall 2020. We intend to describe initial findings of a pilot study examining both the efficacy of the ‘Let’s Move’ initiative and to trend inflammatory cytokines in patients exposed to the early mobilization initiative as compared to our standard mobilization to investigate any links to outcomes.

Methods: Following informed consent, qualifying patients (figure 1) are randomized to either the control arm or the ‘Let’s Move’ arm until a total of 30 patients are enrolled. Accelerometers are used to quantify movement on all patients. IL-6, IL-8, IL-10 and TNF-alpha are collected routinely. Patients in the ‘Let’s Move’ arm receive up to two mobilization sessions daily.

Results: Data collection has been completed for 10 patients. They ranged in age from 2-12 years with 7 males and 3 females. 6 patients have been randomized to the control arm with 4 in the ‘Let’s Move’ arm. No adverse events have occurred. The patients in the control arm have had an ICU length of stay (LOS) ranging from 95.4-216 hours and hospital LOS of 159-554.6 hours. The patients in the ‘Let’s Move’ arm have had an ICU LOS ranging from 120-325 hours and hospital LOS of 195.8-505.7 hours. Illness severity has varied between groups with a PIM2 score of 0.9-22.7% in the control arm and 1.2-12.6% in the intervention arm. Cytokines are shown in table 1.

Conclusion: Early mobilization continues to be shown to be safe in children, with no adverse events occurring during mobilization in our study. Our ability to mobilize patients has been limited by nursing comfort, however with education this continues to improve. Due to the ongoing nature of our study, with initial results available on a small cohort of patients, statistical significance cannot be fully assessed at this time. However, when evaluating the mean values of the pro- and anti-inflammatory markers examined it does appear that the ‘Let’s Move’ arm had a greater degree of change between the first and last day of blood collection. Given the absence of data regarding mechanisms behind improved outcomes in critically ill patients who receive early mobilization this remains an important avenue for continued research.