Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States
Kudchadkar, Sapna R; Nelliot, Archana; Awojoodu, Ronke; Vaidya, Dhananjay; Traube, Chani; Walker, Tracie; Needham, Dale M; Agus, Michael S D; Coughlin-Wells, Kerry; Babbitt, Christopher J; Basnet, Sangita; Spenner, Allison; Bailey, Christine; Lee, Kristen N; Behrens, Deanna; Donovan, Ramona; Betters, Kristina A; Canter, Marguerite O; Bone, Meredith F; VandenBranden, Sara; Bysani, Gokul Kris; Chrisman, Maddie; Fink, Ericka L; Christie, LeeAnn; Christopher, Jean; Cifra, Christina; Lilitwat, Weerapong; Cooper, David S; Rice, Alicia; Cowl, Allison S; Custer, Jason W; Chung, Melissa G; Van Damme, Danielle; Smith, Kristen A; Dixon, Rebecca; Dorfman, Molly V; Mancini, Ashley; Dial, Sharon P; Di Gennaro, Jane L; Dervan, Leslie A; Doughty, Lesley; Benken, Laura; Dugan, Mark C; Ari, Judith Ben; Flaigle, Melanie Cooper; Smith, Vianne; Gertz, Shira J; Gregersen, Katherine; Abd-Allah, Shamel A; Hamrick, Justin; Irby, Katherine; Herbsman, Jodi; Al-Qaqaa, Yasir M; Holcroft, John; Hulfish, Erin; Culver, Kathleen; Hupp, Susan; DeMonbrun, Andrea; Iheagwara, Kelechi; Lavigne-Sims, Shelli; Joyce, Christine; Traube, Chani; Kamat, Pradip; Stone, Cheryl; Kamath, Sameer S; Harward, Melissa; Kaszubski, Priscilla; Daguanno, Joanne; Kavanagh, Robert P; Spear, Debbie; Kawai, Yu; Fryer, Karen; Kramer, Bree; Kreml, Erin M; Burrows, Brian T; Kiragu, Andrew W; Lane, John; Le, Truc M; Williams, Stacey R; Lin, John C; Florin, Amanda; Luckett, Peter M; Robertson, Tammy; Madrigal, Vanessa N; Harlow, Ashleigh B; Markovitz, Barry; Beltramo, Fernando; McCrory, Michael C; McKinney, Robin L; Naim, Maryam Y; Nair, Asha G; Thiagarajan, Ravi; Narayan, Shilpa; Murkowski, Kathleen; Gowda, Keshava Murthy Narayana; See, Jhoclay; Nawathe, Pooja A; Novotny, William E; Keel, Cynthia; Oishi, Peter; Marupudi, Neelima; Ortmann, Laura; O'Meara, A M Iqbal; Miller Ferguson, Nikki; Peters, Megan E; Pinto, Neethi; Kniola, Allison; Rowan, Courtney M; Mazurczyk, Jill; Shah, Shilpa; Lachman, Sage; Singleton, Marcy N; Nett, Sholeen T; Spaeder, Michael C; Zschaebitz, Jenna V; Spentzas, Thomas; Sreedhar, Sue S; Steffen, Katherine M; Chen, Michelle; Stormorken, Anne; Blatz, Allison; Tadphale, Sachin D; Tasker, Robert C; Griffin, John F; Uhl, Tammy L; Harward, Melissa; Walson, Karen H; Bates, Cynthia; Watson, Christopher M; Sheram, Mary Lynn; Williams, Cydni N; Kirby, Aileen; Wolf, Michael; Lowry, Kellet; Wolfe, Heather A; Yates, Andrew R; Beckman, Brian
OBJECTIVES/OBJECTIVE: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/METHODS:National 2-day point prevalence study. SETTING/METHODS:Eighty-two PICUs in 65 hospitals across the United States. PATIENTS/METHODS:All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day. INTERVENTIONS/METHODS:None. MEASUREMENTS AND MAIN RESULTS/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.
PMID: 32168030
ISSN: 1530-0293
CID: 4382872
Early mobilization in the pediatric intensive care unit [Meeting Abstract]
Alqaqaa, Y; Herbsman, J; Folks, T; O'Donnell, S; Klien, D; Seilikoff, L; Sheldon, M E
Learning Objectives: 1. Assess the impact and feasibility of an early mobilization program in the Pediatric Intensive Care Unit (PICU). 2. Increase percent of PICU patients mobilized within recommended time frame to 80% (from 56%) -timeframe defined as 18 hours for non-mechanically ventilated (MV) patients and 48 hours for MV patients. 3. Decrease PICU LOS Methods: Design: Quality improvement (QI) project with preand post-intervention groups. Setting: 12 bedded PICU in an academic medical center Patients: 73 patients in the pre-intervention group and 110 patients in the post-intervention group. Interventions: A survey was developed to identify barriers to mobilization. An algorithm was created to help identify children appropriate for mobilization. Education and training was completed on the benefits of early mobilization and techniques to safely mobilize critically ill children. Family advisors assisted in incorporating patient and family feedback into staff education. Measurements: Mobilization rate; incidence of safety events, Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP) orders, ICU and hospital LOS, discharge disposition Results: Percent of patients mobilized within allotted time frame increased from 56% to 82%. Percent of patients with PT, OT, and SLP orders increased by 7%, 10% and 1% respectively. For the non-MV group, hospital length of stay decreased from 6.1 to 4.2 days, PICU LOS decreased from 3.5 to 2.4 days and percent of patients discharged home increased from 85% to 95% versus discharge to facility. For non-MV patients the average PICU LOS decreased from 3.5 to 2.4 days (p = .012). Length of stay was correlated with early mobilization (r =-.20, p = .008), as measured across the pre-and post-intervention time periods. The total LOS decreased from 6.1 to 4.2 days. The correlation between LOS and mobilization, r =-.20, was maintained whether considering total hospital length of stay or length of stay in the PICU only. For MV patients, the average PICU LOS increased from 12.1 to 12.5 days (3% increase) and the overall average hospital LOS decreased from 15.3 to 14.8 days (3% decrease). Conclusions: Early mobilization in the PICU is safe and effective and can increase percentage of patients mobilized, and percent of patients with PT and OT orders. Early mobilization is associated with decreased PICU and floor LOS and increased percent of patients discharged to home in non-mechanically ventilated patients
EMBASE:620080850
ISSN: 1530-0293
CID: 2924112