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Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States.

Publication ,  Journal Article
Kudchadkar, SR; Nelliot, A; Awojoodu, R; Vaidya, D; Traube, C; Walker, T; Needham, DM ...
Published in: Crit Care Med
May 2020

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.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

May 2020

Volume

48

Issue

5

Start / End Page

634 / 644

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Severity of Illness Index
  • Physical Therapy Modalities
  • Physical Functional Performance
  • Patient Safety
  • Occupational Therapy
  • Male
  • Intensive Care Units, Pediatric
  • Infant
 

Citation

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Kudchadkar, S. R., Nelliot, A., Awojoodu, R., Vaidya, D., Traube, C., Walker, T., … Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, . (2020). Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med, 48(5), 634–644. https://doi.org/10.1097/CCM.0000000000004291
Kudchadkar, Sapna R., Archana Nelliot, Ronke Awojoodu, Dhananjay Vaidya, Chani Traube, Tracie Walker, Dale M. Needham, and Dale M. Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. “Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States.Crit Care Med 48, no. 5 (May 2020): 634–44. https://doi.org/10.1097/CCM.0000000000004291.
Kudchadkar SR, Nelliot A, Awojoodu R, Vaidya D, Traube C, Walker T, et al. Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med. 2020 May;48(5):634–44.
Kudchadkar, Sapna R., et al. “Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States.Crit Care Med, vol. 48, no. 5, May 2020, pp. 634–44. Pubmed, doi:10.1097/CCM.0000000000004291.
Kudchadkar SR, Nelliot A, Awojoodu R, Vaidya D, Traube C, Walker T, Needham DM, Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med. 2020 May;48(5):634–644.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

May 2020

Volume

48

Issue

5

Start / End Page

634 / 644

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Severity of Illness Index
  • Physical Therapy Modalities
  • Physical Functional Performance
  • Patient Safety
  • Occupational Therapy
  • Male
  • Intensive Care Units, Pediatric
  • Infant