Muscle Changes in Critically Ill Children Following an Early Progressive Exercise in the Paediatric Intensive Care Unit: A Pre- and Post-Intervention Study

Background: Most critically ill children in the paediatric intensive care unit (PICU) are immobilised. Prolonged immobilisation in the PICU negatively affects children's physical health outcomes. Aim: The aim of the study was to evaluate the effectiveness of an early progressive exercise (EPE) intervention to improve the PICU-acquired muscle weakness and to assess the safety of the EPE intervention. Study Design: A single-centre pre- and post-intervention design was adopted. The intervention was the EPE starting within 48–72 h after PICU admission. Primary outcome was the 7-day difference of right rectus femoris muscle cross-sectional area (RRMCSA). Secondary outcomes were the 7-day difference of right rectus femoris muscle thickness (RRMT), the 7-day difference of the right thigh leg circumference, length-of-stay, functional status score (FSS) and the incidence of intervention-related adverse events. Results: Included were 29 children in the pre-intervention group and 32 children in the post-intervention group who did not require mechanical ventilation during PICU admission. The 7-day difference of RRMCSA in the post-intervention group was smaller than in the pre-intervention group, (−0.13 ± 0.13 cm² versus −0.28 ± 0.10 cm², p < 0.001). The RRMT at 7-day was also smaller in the post-intervention group (−0.08 ± 0.09 cm versus −0.23 ± 0.08 cm, p < 0.001). FSS of the post-intervention group was significantly lower than that of the pre-intervention group (p < 0.05). Differences in right thigh circumference, and length-of-stay were not observed between both groups. Children in the post-intervention group completed a total of 224 exercise sessions (completion rate 99.2%). No adverse events were observed. Conclusions: EPE slowed muscle atrophy and was safe and feasible in children without mechanical ventilatory support in the PICU. Further research needs to confirm early rehabilitation on short-term and long-term physical health outcomes after PICU discharge. Relevance to Clinical Practice: PICU nurses should consider using early progressive exercise in critically ill children in the PICU and have parents involved in these early rehabilitation programmes. Trial Registration: Chinese Clinical Trial Registry https://www.chictr.org.cn/indexEN.html number: ChiCTR2100047629.