Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States
Sapna R Kudchadkar, Archana Nelliot, Ronke Awojoodu, Dhananjay Vaidya, Chani Traube, Tracie Walker, Dale M Needham, Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Michael S D Agus, Kerry Coughlin-Wells, Christopher J Babbitt, Sangita Basnet, Allison Spenner, Christine Bailey, Kristen N Lee, Deanna Behrens, Ramona Donovan, Kristina A Betters, Marguerite O Canter, Meredith F Bone, Sara VandenBranden, Gokul Kris Bysani, Maddie Chrisman, Ericka L Fink, LeeAnn Christie, Jean Christopher, Christina Cifra, Weerapong Lilitwat, David S Cooper, Alicia Rice, Allison S Cowl, Jason W Custer, Melissa G Chung, Danielle Van Damme, Kristen A Smith, Rebecca Dixon, Molly V Dorfman, Ashley Mancini, Sharon P Dial, Jane L Di Gennaro, Leslie A Dervan, Lesley Doughty, Laura Benken, Mark C Dugan, Judith Ben Ari, Melanie Cooper Flaigle, Vianne Smith, Shira J Gertz, Katherine Gregersen, Shamel A Abd-Allah, Justin Hamrick, Katherine Irby, Jodi Herbsman, Yasir M Al-Qaqaa, John Holcroft, Erin Hulfish, Kathleen Culver, Susan Hupp, Andrea DeMonbrun, Kelechi Iheagwara, Shelli Lavigne-Sims, Christine Joyce, Chani Traube, Pradip Kamat, Cheryl Stone, Sameer S Kamath, Melissa Harward, Priscilla Kaszubski, Joanne Daguanno, Robert P Kavanagh, Debbie Spear, Yu Kawai, Karen Fryer, Bree Kramer, Erin M Kreml, Brian T Burrows, Andrew W Kiragu, John Lane, Truc M Le, Stacey R Williams, John C Lin, Amanda Florin, Peter M Luckett, Tammy Robertson, Vanessa N Madrigal, Ashleigh B Harlow, Barry Markovitz, Fernando Beltramo, Michael C McCrory, Robin L McKinney, Maryam Y Naim, Asha G Nair, Ravi Thiagarajan, Shilpa Narayan, Kathleen Murkowski, Keshava Murthy Narayana Gowda, Jhoclay See, Pooja A Nawathe, William E Novotny, Cynthia Keel, Peter Oishi, Neelima Marupudi, Laura Ortmann, AM Iqbal O’Meara, Nikki Miller Ferguson, Megan E Peters, Neethi Pinto, Allison Kniola, Courtney M Rowan, Jill Mazurczyk, Shilpa Shah, Sage Lachman, Marcy N Singleton, Sholeen T Nett, Michael C Spaeder, Jenna V Zschaebitz, Thomas Spentzas, Sue S Sreedhar, Katherine M Steffen, Michelle Chen, Anne Stormorken, Allison Blatz, Sachin D Tadphale, Robert C Tasker, John F Griffin, Tammy L Uhl, Melissa Harward, Karen H Walson, Cynthia Bates, Christopher M Watson, Mary Lynn Sheram, Cydni N Williams, Aileen Kirby, Michael Wolf, Kellet Lowry, Heather A Wolfe, Andrew R Yates, Brian Beckman, Sapna R Kudchadkar, Archana Nelliot, Ronke Awojoodu, Dhananjay Vaidya, Chani Traube, Tracie Walker, Dale M Needham, Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Michael S D Agus, Kerry Coughlin-Wells, Christopher J Babbitt, Sangita Basnet, Allison Spenner, Christine Bailey, Kristen N Lee, Deanna Behrens, Ramona Donovan, Kristina A Betters, Marguerite O Canter, Meredith F Bone, Sara VandenBranden, Gokul Kris Bysani, Maddie Chrisman, Ericka L Fink, LeeAnn Christie, Jean Christopher, Christina Cifra, Weerapong Lilitwat, David S Cooper, Alicia Rice, Allison S Cowl, Jason W Custer, Melissa G Chung, Danielle Van Damme, Kristen A Smith, Rebecca Dixon, Molly V Dorfman, Ashley Mancini, Sharon P Dial, Jane L Di Gennaro, Leslie A Dervan, Lesley Doughty, Laura Benken, Mark C Dugan, Judith Ben Ari, Melanie Cooper Flaigle, Vianne Smith, Shira J Gertz, Katherine Gregersen, Shamel A Abd-Allah, Justin Hamrick, Katherine Irby, Jodi Herbsman, Yasir M Al-Qaqaa, John Holcroft, Erin Hulfish, Kathleen Culver, Susan Hupp, Andrea DeMonbrun, Kelechi Iheagwara, Shelli Lavigne-Sims, Christine Joyce, Chani Traube, Pradip Kamat, Cheryl Stone, Sameer S Kamath, Melissa Harward, Priscilla Kaszubski, Joanne Daguanno, Robert P Kavanagh, Debbie Spear, Yu Kawai, Karen Fryer, Bree Kramer, Erin M Kreml, Brian T Burrows, Andrew W Kiragu, John Lane, Truc M Le, Stacey R Williams, John C Lin, Amanda Florin, Peter M Luckett, Tammy Robertson, Vanessa N Madrigal, Ashleigh B Harlow, Barry Markovitz, Fernando Beltramo, Michael C McCrory, Robin L McKinney, Maryam Y Naim, Asha G Nair, Ravi Thiagarajan, Shilpa Narayan, Kathleen Murkowski, Keshava Murthy Narayana Gowda, Jhoclay See, Pooja A Nawathe, William E Novotny, Cynthia Keel, Peter Oishi, Neelima Marupudi, Laura Ortmann, AM Iqbal O’Meara, Nikki Miller Ferguson, Megan E Peters, Neethi Pinto, Allison Kniola, Courtney M Rowan, Jill Mazurczyk, Shilpa Shah, Sage Lachman, Marcy N Singleton, Sholeen T Nett, Michael C Spaeder, Jenna V Zschaebitz, Thomas Spentzas, Sue S Sreedhar, Katherine M Steffen, Michelle Chen, Anne Stormorken, Allison Blatz, Sachin D Tadphale, Robert C Tasker, John F Griffin, Tammy L Uhl, Melissa Harward, Karen H Walson, Cynthia Bates, Christopher M Watson, Mary Lynn Sheram, Cydni N Williams, Aileen Kirby, Michael Wolf, Kellet Lowry, Heather A Wolfe, Andrew R Yates, Brian Beckman
Abstract
Objectives: With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers.
Design: National 2-day point prevalence study.
Setting: Eighty-two PICUs in 65 hospitals across the United States.
Patients: All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day.
Interventions: None.
Measurements and main results: The primary outcome was prevalence of physical therapy- or occupational therapy-provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility-associated safety events, and barriers to mobility. The point prevalence of physical therapy- or occupational therapy-provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13-17 vs < 3 yr, 2.1; 95% CI, 1.5-3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61-0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1-0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1-0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1-6.6).
Conclusions: Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.
Conflict of interest statement
Copyright form disclosure: The authors have disclosed that they do not have any potential conflicts of interest.
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Source: PubMed