541 - Kidneys in Motion: Early Mobility Practices in Pediatric Patients on Continuous Renal Replacement Therapy – A Mixed-Methods Study

Publication Number: 4529.541

Laura Rangel Rodriguez, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Harsh Agrawal, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States; Brigid C. Griffin, Cincinnati Children's Hospital, Cincinnati, OH, United States; Danielle Maue, Cincinnati Children's Hospital Medical Center, Liberty Twp, OH, United States; Carlie Myers, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Early mobilization is standard of care in critically ill children, but remains uncommon among those receiving continuous renal replacement therapy (CRRT) due to safety concerns and workflow barriers. These patients face increased risk of ICU-acquired weakness, leading to poor outcomes and reduced quality of life. Although mobilization during CRRT is feasible and safe, pediatric data is limited. This study evaluates current mobilization practices, safety outcomes, and provider perceived barriers to inform a standardized mobilization protocol for pediatric CRRT patients in the pediatric intensive care unit (PICU).

Objective: To characterize current mobilization practices and identify barriers, safety concerns, and provider perspectives to guide interventions that increase active mobility in pediatric CRRT patients.

Design/Methods: Single-center mixed-methods study of PICU patients on CRRT at Cincinnati Children’s Hospital (Sept 2024–Sept 2025). Retrospective chart review captured demographics, PT/OT sessions, mobility levels, and safety events. A multidisciplinary survey assessed barriers, facilitators, and provider comfort with mobilization. Descriptive statistics summarized practices and outcomes; survey data identified targets for improvement. Findings will guide upcoming quality improvement interventions.

Results: Among 28 pediatric patients on CRRT (median age 12y [IQR: 5,13]), median CRRT duration was 9d [IQR: 5,27] and PICU stay 26d [IQR: 17,48]; 47% survived to discharge (Table 1). Across 156 PT sessions, mobility was primarily passive or in-bed (Table 2). Barriers included patient unavailability due to nursing deferral, procedures, and clinical instability. No major safety events occurred; transient physiologic changes were reported in 6 patients (1 required intervention). Provider survey (n=98, including RNs, RTs, PT/OTs, nephrology and PICU physicians), 27% participated in active mobilization, most commonly transfers out of bed. Top perceived barriers were CRRT interruption and alarms; facilitators included protocol standardization, simulation, and communication (Figure 1).

Conclusion(s): Mobilization of pediatric CRRT patients is feasible and safe but underutilized. Retrospective findings confirm low adverse-event risk, while survey data highlight modifiable provider-and system-level barriers. These results inform the next phase of this initiative—a prospective, quality improvement program to implement and evaluate a standardized CRRT mobilization protocol aimed at increasing active mobility and improving functional outcomes.

Confirmation fellow status
Rangel-Rodriguez Letter for ASPN Trainee Research Awards.pdf

Table 2. Highest level of mobility achieved during Physical Therapy on CRRT (n=156)
Table 2 PAS.pdf*Barriers included: clinical stability, RN deferred and patient unavailability

Figure 1. Survey responses barriers and facilitators
Figure 1.pdf