Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study-Reference-Cited by-同舟云学术

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Published:2024-02-02 Issue: Volume: Page:
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Choong Karen¹²,Fraser Douglas D.³,Cameron Saoirse⁴,Cuello Carlos²,Debigaré Sylvie⁵,Ewusie Joycelyne⁶,Kho Michelle E.⁷,Krasevich Kimberley¹,Martin Claudio M.³,Thabane Lehana²,Todt Ashley⁵,Cupido Cynthia¹,

Affiliation:

1. Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.

2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

3. Division of Critical Care, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

4. Lawson Health Research Institute, Children’s Hospital, London Health Sciences Centre, London, ON, Canada.

5. Family Partner, McMaster Children's Hospital, Hamilton, ON, Canada.

6. The Research Institute, Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, ON, Canada.

7. School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

Abstract

Objectives: To compare post-PICU discharge functioning, health-related quality of life (HRQL), and parental stress before and after the implementation of an early rehabilitation bundle. Design and Setting: Prospective cohort substudy within an early rehabilitation implementation program, conducted at the PICUs at McMaster Children’s Hospital and London Health Sciences, London, Ontario, Canada. Interventions: A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. Patients with an anticipated 48-hour PICU length of stay were approached for consent to participate. Patients: Critically ill children with an anticipated 48-hour PICU length of stay were approached for consent to participate. Measurements and Main Results: Patient-/proxy-reported outcome measures were assessed at baseline, PICU discharge, and 1 and 3 months post-PICU discharge using: 1) Pediatric Evaluation of Disability Inventory Computer Adaptive Test to assess physical, social, cognitive, and responsibility/caregiver domains of functioning; 2) KIDSCREEN to assess HRQL; and 3) the Pediatric Inventory for Parents to assess caregiver stress. A total of 117 participants were enrolled. Patient demographic characteristics were similar in the pre- and post-intervention groups. Following bundle implementation, 30 of 47 respondents (63.8%) experienced functional decline and 18 of 45 (40%) experienced low HRQL at PICU discharge. Eighteen of 36 (50%) at 1 month and 14 of 38 (36.8%) at 3 months experienced either persistent functional decline and/or low HRQL; 2.8% and 2.6% at 1- and 3-month follow-up, respectively, experienced both persistent functional decline and low HRQL. There were no significant differences in the rates of persistent functional decline, low HRQL, or caregiver stress scores post-bundle compared with pre-rehabilitation bundle implementation. Conclusions: We were unable to adequately determine the efficacy of a rehabilitation bundle on patient-centered outcomes as this substudy was not powered for these outcomes. Our results did reveal that persistent low functioning is common in PICU survivors, more common than low HRQL, while experiencing both functional decline and low HRQL was uncommon.

Funder

AFP Innovation Fund

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

Reference23 articles.

1. Post-intensive care syndrome: Its pathophysiology, prevention, and future directions.;Inoue;Acute Med Surg,2019

2. Conceptualizing post intensive care syndrome in children—the PICS-p framework.;Manning;Pediatr Crit Care Med,2018

3. Life after critical illness in children-toward an understanding of pediatric post-intensive care syndrome.;Watson;J Pediatr,2018

4. Postintensive care syndrome in pediatric critical care survivors: Therapeutic options to improve outcomes after acquired brain injury.;Williams;Curr Treat Options Neurol,2019

5. Early rehabilitation in critically ill children: A two center implementation study.;Choong;Pediatr Crit Care Med,2024