Consensus-based recommendations to support implementation of early mobilisation in the paediatric intensive care unit: an ESPNIC position statement

Immobilisation in the paediatric intensive care unit (PICU) may contribute to Post-Intensive Care Syndrome in Paediatrics (PICS-p). Although early mobilisation is safe and feasible in critically ill children, its implementation remains limited. Less than 15% of European PICUs utilize a formal protocol, largely due to safety concerns and lack of standardized guidance. This ESPNIC position statement provides evidence‑informed, consensus‑based recommendations to support the implementation of early mobilisation in routine PICU practice. A literature review was conducted to identify characteristics of early mobilisation, as well as barriers and facilitators to its implementation in PICU settings. These findings informed a Delphi study to establish consensus among ESPNIC PICU experts, including physicians, nurses, physiotherapists, occupational therapists, and nurse practitioners. Participants rated the importance of each recommendation on a 9-point Likert scale and consensus was defined as ≥80% agreement. Twenty‑one studies informed the development of 39 recommendations spanning six domains: definition, risk assessment, exclusion criteria, mobility activities, progression, and implementation strategies. Twenty‑nine PICU professionals from six countries participated in the Delphi study. All recommendations achieved consensus in the first round. Key recommendations include a shared definition of early mobilisation, structured safety assessment, developmentally appropriate mobility activities, daily multidisciplinary goal‑setting, and implementation strategies. This ESPNIC position statement offers practical, consensus-based recommendations to support the safe, developmentally appropriate, and sustainable implementation of early mobilisation in critically ill children. These recommendations aim to standardize practice, address implementation barriers, and facilitate wider uptake of early mobilisation in PICUs.