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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

Adjunctive Therapies During Extracorporeal Membrane Oxygenation to Enhance Multiple Organ Support in Critically Ill Children

Canter, Marguerite Orsi; Daniels, Jessica; Bridges, Brian C
Since the advent of extracorporeal membrane oxygenation (ECMO) over 40 years ago, there has been increasing interest in the use of the extracorporeal circuit as a platform for providing multiple organ support. In this review, we will examine the evidence for the use of continuous renal replacement therapy, therapeutic plasma exchange, leukopheresis, adsorptive therapies, and extracorporeal liver support in conjunction with ECMO.
PMID: 29670870
ISSN: 2296-2360
CID: 3855142


Doymaz, Sule; Rizvi, Munaza; Sinha, Virteeka; Canter, Marguerite Orsi; Stefanov, Dimitre; Kim, Jane
ISSN: 0090-3493
CID: 3855162

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

Karp, Robert J; Wong, Gary; Orsi, Marguerite
INTRODUCTION/BACKGROUND:Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. OBJECTIVES/OBJECTIVE:We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. METHODS:Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. RESULTS:Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. CONCLUSION/CONCLUSIONS:Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.
PMID: 26255545
ISSN: 0300-9831
CID: 3855152