PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians*

Treble‐Barna, Amery; Beers, Sue R.; Houtrow, Amy J.; Ortiz-Aguayo, Roberto; Valenta, Cynthia; Stanger, Meg; Chrisman, Maddie; Orringer, Maxine; Smith, Craig; Pollon, Dorothy; Duffett, Mark; Choong, Karen; Watson, R. Scott; Kochanek, Patrick M.; Fink, Ericka L.

doi:10.1097/pcc.0000000000001940

Cited by 22 publications

(9 citation statements)

References 34 publications

(34 reference statements)

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“…Improved screening tests are needed to help to identify children at highest risk. Long-term follow-up of patients by PICU teams is rare, and the use of multidisciplinary follow-up programs, even more so [ 113 ]. Until better screening tools exist to reliably identify high risk patients, providers should have a low threshold for referral to available outpatient therapy and psychology.…”

Section: Screening and Identification Of At-risk Patientsmentioning

confidence: 99%

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

Woodruff

Choong

2021

Children

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Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.

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Section: Screening and Identification Of At-risk Patientsmentioning

confidence: 99%

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

Woodruff

Choong

2021

Children

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“…Because a validated questionnaire on the study topic was not available, five experts with expertise in paediatric critical care and survey research developed a 17-item pertinent questionnaire. The items were selected on the basis of a review of the literature on early mobilisation, 9,[18][19][20]22 and categorised into four parts. The first part con- A pilot test was performed among eight PICU health care professionals (PICU nurses, physicians and physical therapists) from two PICUs to assess the clarity, comprehensiveness and face validity of the questionnaire.…”

Section: Survey Developmentmentioning

confidence: 99%

“…18 Most of the studies investigating PICU staff's views on early mobilisation are from North America. 9,[18][19][20][21] Mobilisation of critically ill children is a multidisciplinary effort of nurses, physical therapists and physicians. 22 Therefore, it is essential to understand the perceived barriers of PICU staff regarding early mobilisation in relation to the context in which they are embedded.…”

Section: Introductionmentioning

confidence: 99%

“…The implementation of early mobilisation programmes in PICUs may be hampered by PICU staff's concerns about the risk of endotracheal tube dislodgement and loss of indwelling central venous catheters 9 as well as the lack of sufficient equipment and perceived increased workload 18 . Most of the studies investigating PICU staff's views on early mobilisation are from North America 9,18–21 . Mobilisation of critically ill children is a multidisciplinary effort of nurses, physical therapists and physicians 22 .…”

Section: Introductionmentioning

confidence: 99%

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Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units

Geven

Maaskant

Woensel

et al. 2022

Nursing in Critical Care

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Background: Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown. In this study, we explored the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff.Methods: A cross-sectional survey study among staff from seven PICUs in the Netherlands has been carried out.Results: Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilize patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient. Conclusion:Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups.Relevance to Practice: We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work.

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“…Early evaluation of PF after PICU discharge could provide crucial information for treatment decisions and to monitor personalized intervention responsiveness. According to parents and healthcare professionals, PF should therefore be universally assessed and treated to optimize recovery from critical illness ( 9 , 17 , 18 ).…”

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confidence: 99%

Physical Functioning After Admission to the PICU: A Scoping Review

Bossen

Boer

Knoester

et al. 2021

Critical Care Explorations

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PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians*

Abstract: Objective-Characterize current practices for pediatric intensive care unit (PICU)-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings.

Cited by 22 publications

References 34 publications

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units

Physical Functioning After Admission to the PICU: A Scoping Review

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