Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial

Fink, Ericka L.; Beers, Sue R.; Houtrow, Amy J.; Richichi, Rudolph; Burns, Clare L.; Doughty, Lesley; Ortiz-Aguayo, Roberto; Madurski, Catherine; Valenta, Cynthia; Chrisman, Maddie; Golightly, Lynn; Kiger, Michelle; Patrick, Cheryl; Treble‐Barna, Amery; Pollon, Dorothy; Smith, Craig; Kochanek, Patrick M.

doi:10.1097/pcc.0000000000001881

Cited by 32 publications

(41 citation statements)

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“…Only 0.2% of all mobility events were associated with dislodgement of a device, comparable to the 0.6% rate in adults [20]. Therefore, our data, in parallel with evidence from single-centre PICU studies [21,22], suggest that mobilization of PICU patients is safe. There are several important similarities and differences with the USA-PARK-PICU findings [12], a retrospective Canadian multicentre PICU study [23], and adult point prevalence studies of ICU mobilization practices [18].…”

Section: Discussionsupporting

confidence: 74%

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

et al. 2020

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Background: Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. Methods: A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)-or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Results: Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT-and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Conclusion: Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.

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Section: Discussionsupporting

confidence: 74%

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

et al. 2020

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“…This finding is consistent with prior literature suggesting that less than half of this population receive PICU rehabilitation services as a part of usual care [ 32 – 34 ]. Recent randomized control trials have found it feasible and safe to increase PICU-based rehabilitation services [ 35 , 36 ], and acute rehabilitation is the only intervention that has been identified thus far for improving physical function in critically ill patients [ 37 , 38 ]. Inclusion of rehabilitation services in the care of PICU patients allows for personalized strategic plans to be implemented for patients and families that can facilitate a smoother transition home and improve child and family outcomes.…”

Section: Discussionmentioning

confidence: 99%

Caregiver dissatisfaction with their child’s participation in home activities after pediatric critical illness

et al. 2020

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Background Pediatric critical care is often accompanied by a variety of functional impairments. Preliminary evidence suggests children’s participation in home activities has a slow trajectory post-pediatric intensive care unit (PICU) discharge, however, additional and more granular knowledge on specific problematic activities is needed to inform patient-centric rehabilitative care. The objectives of this study are to identify common home activities in which caregivers’ report dissatisfaction and to determine predictors of caregivers’ dissatisfaction with their child’s participation in home activities post-PICU discharge. Methods Secondary analyses of data from a prospective cohort study, the Wee-Cover study, using a subsample of caregivers (N = 170) of children 1–17 years, admitted to a PICU ≥48 h with data on our primary outcome measure from at least one time point. Data were gathered at enrollment and at 3 and 6 months post-PICU discharge. Caregivers reported on their dissatisfaction with their child’s participation in home activities via the Participation and Environment Measure. Common activities were identified by plotting caregiver dissatisfaction for each activity pre-and post-PICU, reporting activities in which ≥50% of caregivers reported dissatisfaction with post-PICU, and assessing for significantly different dissatisfaction levels between time-points for each activity. Predictors of caregiver dissatisfaction were assessed using Poisson generalized estimated equation models. Results There was variability in reported dissatisfaction across all activities; ≥50% of caregivers reported dissatisfaction with five activities, including getting clean, personal care management, and mealtime for younger children and household chores and homework for school-aged children and youth. Four activities had significantly higher caregiver dissatisfaction post-PICU: sleep (children < 5 years), homework, indoor play and games, and computer/video games (children ≥5 years). Home environmental support and the interaction of having participation-focused strategies with receiving PICU-based rehabilitation services were negatively associated with caregiver dissatisfaction. Increased caregiver stress and functional performance were associated with increased dissatisfaction. Conclusions Individualized PICU-based rehabilitation services to determine family priorities and develop participation-focused strategies, specifically those increasing environmental supports within the home, may ease the family’s transition home post-PICU. Trial registration ClinicalTrials.gov Identifier NCT02148081 05/28/2014.

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“…35 The results of this review suggest that levels of comfort with mobilization may be evolving with increasing safety and feasibility data in children and indirect evidence from the adult population. Cardiorespiratory instability 20,21 Mortality (no. of deaths recorded) 1220 (9 observational studies) ⊕○○○ Very low †, ‡, § Across 9 studies, 4 deaths were reported among 494 children receiving mobilization (0.8%) vs 27 of 720 (3.75%) in control group.…”

Section: Discussionmentioning

confidence: 99%

“…23,26 Four studies used interactive videogames and/ or in-bed cycling to facilitate mobilization. 3,22-24 "Early" mobilization was defined as within 48 hours of PICU admission in 3 studies 21,29,30 and 72 hours of PICU admission in another. 26 The wEECYCLE pilot RCT evaluated early mobilization practice guidelines as their standard of care, which recommended screening for appropriateness within 24 hours of PICU admission, and defined early as when contraindications are absent and a set of systems-based safety criteria are met.…”

Section: Mobility Interventions Timing and Definitions Of "Early"mentioning

confidence: 99%

Early Mobilization in Critically Ill Children: A Systematic Review

Cuello-Garcia¹,

Chuen²,

Simpson³

et al. 2018

The Journal of Pediatrics

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Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial

Abstract: TWEET Early, ICU-based and personalized physical, occupational, and speech and language therapy sessions were feasible and safe in pediatric neurocritical care patients.

Cited by 32 publications

References 50 publications

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

Caregiver dissatisfaction with their child’s participation in home activities after pediatric critical illness

Early Mobilization in Critically Ill Children: A Systematic Review

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