Acute rehabilitation in critically ill children

Article type: Research Article

Authors: Choong, Karen^{; ; ;} | Tran, Nga | Clark, Heather | Cupido, Cynthia^; | Corsi, Daniel J.

Affiliations: Department of Pediatrics, McMaster University, Hamilton, ON, Canada | Department of Critical Care, McMaster University, Hamilton, ON, Canada | Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada | Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

Note: [] Corresponding author: Karen Choong, McMaster Children’s Hospital, 1200 Main Street West, Room 3A-78, Hamilton, Ontario, L8N 3Z5, Canada. Tel.: +1 905 5212100; Ext. 75617; Fax: +1 905 5245707; E-mail: choongk@mcmaster.ca.

Abstract: Immobility increases morbidity, while early mobilization improves outcomes in adults. Rehabilitation practices in critically ill children, and the degree to which they are immobilized, are currently not well understood. The objective of this retrospective cohort study was to evaluate acute rehabilitation practices and potential barriers to mobilization in a tertiary care pediatric critical care unit (PCCU). Children aged less than 18 yr with a greater than 24 h length of stay were eligible. Outcomes of interest were physical therapy (PT) practice patterns, predictors of immobility, and adverse sequelae attributable to immobility. Interventions were classified as non-mobility and mobility types of PT. Ninety-one patients were included, 46.2% (42/91) were males. The mean age was 6.4 ± 6.4 yrs. Thirty-six of ninety-one (39.6%) patients received some form of PT while in PCCU. The mean proportion of PCCU days during which PT occurred was 20% (SD 28.8), and 3% (3/91) of patients received PT daily. Sixteen patients (17.6%) received exclusively non-mobility PT, 20 (22.0%) received some form of mobility, and six (6.6%) received both non-mobility and mobility PT. Increased severity of illness, mechanical ventilation, baseline disability and young age were identified barriers to mobilization. Immobilization is common in critically ill children. PT was often delayed until the patient was stabilized, and when performed was focused on respiratory function. Mobility PT was reserved for less sick, older, and non-mechanically ventilated patients. Future research is necessary to evaluate the significance of immobility and its impact on clinical outcomes in this population.

Keywords: Pediatric critical care, physical therapy, rehabilitation, mobilization

DOI: 10.3233/PIC-12031

Journal: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 183-192, 2012