Consensus statement on the use of standardized early mobilization in pediatric patients admitted to pediatric intensive care units in Italy.

UNLABELLED: Prolonged immobility contributes to pediatric intensive care unit (PICU)-acquired weakness and postintensive care syndrome (PICS). Early mobilization (EM) shows feasibility and potential benefits in adults, and pediatric experiences suggest safety, though data are limited and practice varies. There is a wide variability in Italy regarding EM practices. Thus, we aimed to develop consensus statements to standardize EM across Italian PICUs today while respecting local variability. This project was conducted by a 20-member multidisciplinary panel of Italian PICU experts, including nurses and physiotherapists. The project was endorsed by the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). A comprehensive search (2010-2015 July 2025) in PubMed, CINAHL, and PEDro was conducted. Eligible studies included prospective and retrospective studies, systematic reviews, meta-analyses, and guidelines. Nine EM research areas were defined; Statements were drafted using a Quaker-based consensus methodology and voted using the RAND/UCLA appropriateness method. From 8380 records, 113 studies met eligibility. Twenty-two statements and four tables were drafted; 20 statements and three tables achieved strong agreement in the first round. The remaining two statements and one table were revised and were classified with weak agreement. Attendance was 93% at online meetings.

CONCLUSION

This EM consensus provides standardized, implementable statements to guide EM adoption across Italian PICUs while accommodating local practice differences; future work should focus on validation, implementation, and dissemination.

WHAT IS KNOWN: • Prolonged immobility in the PICU is one of the modifiable factors associated with PICU-acquired weakness, delirium, and post-intensive care syndrome. • In Italy only 15% of patients admitted to PICU receives Early Mobilization practices with great variability across PICUs.

WHAT IS NEW: • 22 pragmatic statements and four tables have been developed to promote standardized EM interventions across Italian PICUs, while accounting for variability of practices and equipment. • The provision of graded Early Mobilization, responsive to the child's condition and severity of illness, may promote functional recovery both during and beyond the PICU stay.