• Norihiko Tsuboi, Miku Hiratsuka, Setsushi Kaneko, Nao Nishimura, Satoshi Nakagawa, Mureo Kasahara, and Takeshi Kamikubo.
• Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
• Pediatr Crit Care Me. 2019 Feb 1; 20 (2): e91-e97.

ObjectiveTo evaluate the impact of early mobilization after pediatric liver transplantation in the PICU.DesignA 70-month retrospective before-after study.SettingMedical and surgical PICU with 20 beds at a tertiary children's hospital.PatientsSeventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery.InterventionWe 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 ResultsThere 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).ConclusionsThrough 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.

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