TY - JOUR
T1 - Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children
AU - on behalf of the PICU Up! Early Mobilization Task Force
AU - Miura, Shinya
AU - Wieczorek, Beth
AU - Lenker, Hallie
AU - Kudchadkar, Sapna R.
N1 - Funding Information:
The authors would like to thank Claire Levine, MS, ELS, in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins, who provided editorial assistance for this manuscript. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Sapna R. Kudchadkar was supported by the Johns Hopkins CTSA Award number 5KL2RR025006 from the National Center for Advancing Translational Sciences of the National Institutes of Health and the Johns Hopkins Bloomberg School of Public Health Sommer Scholars Program.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Sapna R. Kudchadkar was supported by the Johns Hopkins CTSA Award number 5KL2RR025006 from the National Center for Advancing Translational Sciences of the National Institutes of Health and the Johns Hopkins Bloomberg School of Public Health Sommer Scholars Program.
Publisher Copyright:
© The Author(s) 2018.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program. Methods: We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression. Results: Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score (P <.001), baseline motor impairment (P <.01), developmental delay (P =.04), mechanical ventilation (P =.1), and number of devices (P =.01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34). Conclusions: Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.
AB - Background: Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program. Methods: We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression. Results: Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score (P <.001), baseline motor impairment (P <.01), developmental delay (P =.04), mechanical ventilation (P =.1), and number of devices (P =.01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34). Conclusions: Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.
KW - child
KW - critical care
KW - early mobilization
KW - pediatrics
KW - postoperative care
KW - postoperative complications
KW - program development
KW - risk factor
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U2 - 10.1177/0885066618754507
DO - 10.1177/0885066618754507
M3 - Article
C2 - 29357778
AN - SCOPUS:85041598464
SN - 0885-0666
VL - 35
SP - 405
EP - 410
JO - Journal of Intensive Care Medicine
JF - Journal of Intensive Care Medicine
IS - 4
ER -