Document Detail


Acute rehabilitation practices in critically ill children: a multicenter study.
MedLine Citation:
PMID:  24777303     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate acute rehabilitation practices in pediatric critical care units across Canada.
DESIGN: Retrospective cohort study.
SETTING: Six Canadian, tertiary care pediatric critical care units.
PATIENTS/SUBJECTS: Six hundred children aged under 17 years admitted to pediatric critical care unit during a winter and summer month of 2011 with a greater than 24-hour length of stay.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome of interest was the nature and timing of pediatric critical care unit rehabilitation practices.Rehabilitation was classified according to mobility and nonmobility interventions. Predictors of mobilization and the time to mobilization were evaluated through regression and time-dependent survival analyses, respectively. The most common form of rehabilitation provided in pediatric critical care unit was physical therapy (45.5% patients) followed by occupational therapy (4.5%) and speech and language therapy (1.5%). Interventions were primarily nonmobility in nature (69.7% of sessions), most frequently in the form of chest physiotherapy (42.7% of sessions). The median time to mobilization was 2 days (interquartile range, 1-6) as compared with 1 day for nonmobility interventions (interquartile range, 1-3). Only 57 patients (9.5%) received early mobilization. Regression analyses revealed that increasing age, admission during winter, neuromuscular blockade, and sedative infusions were associated with an increased likelihood of receiving mobility therapy. Increasing age was a predictor of early mobilization, while neuromuscular blockade was associated with delayed mobilization. No significant differences in adverse events were found between nonmobility and mobility interventions.
CONCLUSIONS: Only half of the children receive rehabilitation while in the pediatric critical care unit, and when it occurs, therapy is primarily focused on respiratory function. Mobilization appears to be reserved for at-risk children who were muscle relaxed and sedated; however, its implementation in these patients is delayed. Future pediatric-specific research is essential to identify patients at risk and to understand treatment priorities and rehabilitation strategies to improve functional recovery in critically ill children.
Authors:
Karen Choong; Gary Foster; Douglas D Fraser; James S Hutchison; Ari R Joffe; Philippe A Jouvet; Kusum Menon; Eleanor Pullenayegum; Roxanne E Ward;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  15     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-07-08     Completed Date:  -     Revised Date:  2014-12-09    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e270-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research
Investigator
Investigator/Affiliation:
Paul Hebert / ; John C Marshall / ; Karen Choong / ; Andrew Seely / ; Rob Fowler / ; Maureen Meade / ; Elaine Gilfoyle / ; Lauralyn McIntyre / ; Rick Hall / ; Karen Choong / ; Marisa Tucci / ; Jamie Hutchison / ; Denise Foster / ; Lauralyn McIntyre / ; Alexis Turgeon / ; Paul Hebert / ; Francois Lamontagne / ; Elaine Gilfoyle / ; Deborah Cook / ; John Muscedere / ; Tasnim Sinuff / ; John C Marshall / ; Karen Burns / ; Claudio Martin / ; Margaret Herridge /
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2014 Jul;15(6):571-2   [PMID:  25000424 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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