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Quadir A, Festa M, Gilchrist M, Thompson K, Pride N, Basu S. Long-term follow-up in pediatric intensive care-a narrative review. Front Pediatr 2024; 12:1430581. [PMID: 39011062 PMCID: PMC11246917 DOI: 10.3389/fped.2024.1430581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024] Open
Abstract
Pediatric intensive care is a rapidly developing medical specialty and with evolving understanding of pediatric pathophysiology and advances in technology, most children in the developed world are now surviving to intensive care and hospital discharge. As mortality rates for children with critical illness continue to improve, increasing PICU survivorship is resulting in significant long-term consequences of intensive care in these vulnerable patients. Although impairments in physical, psychosocial and cognitive function are well documented in the literature and the importance of establishing follow-up programs is acknowledged, no standardized or evidence-based approach to long-term follow-up in the PICU exists. This narrative review explores pediatric post-intensive care syndrome and summarizes the multifactorial deficits and morbidity that can occur in these patients following recovery from critical illness and subsequent discharge from hospital. Current practices around long-term follow-up are explored with discussion focusing on gaps in research and understanding with suggested ways forward and future directions.
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Affiliation(s)
- Ashfaque Quadir
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Michelle Gilchrist
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kate Thompson
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Pride
- The University of Sydney, Sydney, NSW, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Shreerupa Basu
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
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Yagiela LM, Pfarr MA, Meert K, Odetola FO. Adherence with post-hospitalization follow-up after pediatric critical illness due to respiratory failure. BMC Pediatr 2024; 24:409. [PMID: 38918739 PMCID: PMC11202389 DOI: 10.1186/s12887-024-04888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Adherence with follow-up appointments after a pediatric intensive care unit (PICU) admission is likely a key component in managing post-PICU sequalae. However, prior work on PICU follow-up adherence is limited. The objective of this study is to identify hospitalization characteristics, discharge child health metrics, and follow-up characteristics associated with full adherence with recommended follow-up at a quaternary care center after a PICU admission due to respiratory failure. METHODS We conducted a retrospective cohort study of patients ≤ 18 years with respiratory failure admitted between 1/2013-12/2014 to a quaternary care PICU. Post-hospitalization full adherence with recommended follow-up in the two years post discharge (1/2013-3/2017) at the quaternary care center was quantified and compared by demographics, baseline child health metrics, hospitalization characteristics, discharge child health metrics, and follow-up characteristics in bivariate and multivariate analyses. Patients were dichotomized into being non-adherent with follow-up (patients who attended less than 100% of recommended appointments at the quaternary care center) and fully adherent (patients who attended 100% of recommended appointments at the quaternary care center). RESULTS Of 155 patients alive at hospital discharge, 140 (90.3%) were recommended to follow-up at the quaternary care center. Of the 140 patients with recommended follow-up at the quaternary care center, 32.1% were non-adherent with follow-up and 67.9% were fully adherent. In a multivariable logistic regression model, each additional recommended unique follow-up appointment was associated with lower odds of being fully adherent with follow-up (OR 0.74, 95% CI 0.60-0.91, p = 0.005), and each 10% increase in the proportion of appointments scheduled before discharge was associated with higher odds of being fully adherent with follow-up (OR 1.02, 95% CI 1.01-1.03, p = 0.004). CONCLUSIONS After admission for acute respiratory failure, only two-thirds of children were fully adherent with recommended follow-up at a quaternary care center. Our findings suggest that limiting the recommended follow-up to only key essential healthcare providers and working to schedule as many appointments as possible before discharge could improve follow-up adherence. However, a better understanding of the factors that lead to non-adherence with follow-up appointments is needed to inform broader system-level approaches could help improve PICU follow-up adherence.
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Affiliation(s)
- Lauren M Yagiela
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
- Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA.
| | - Marie A Pfarr
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
| | - Kathleen Meert
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, Mt. Pleasant, MI, USA
| | - Fola O Odetola
- Department of Pediatrics and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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Francoeur C, Alcamo AM, Robertson CL, Wainwright MS, Roa JD, Lovett ME, Stulce C, Yacoub M, Potera RM, Zivick E, Holloway A, Nagpal A, Wellnitz K, Even KM, Brunow de Carvalho W, Rodriguez IS, Schwartz SP, Walker TC, Campos-Miño S, Dervan LA, Geneslaw AS, Sewell TB, Pryce P, Silver WG, Lin JE, Vargas WS, Topjian A, McGuire JL, Domínguez Rojas JA, Tasayco-Muñoz J, Hong SJ, Muller WJ, Doerfler M, Williams CN, Drury K, Bhagat D, Nelson A, Price D, Dapul H, Santos L, Kahoud R, Appavu B, Guilliams KP, Agner SC, Walson KH, Rasmussen L, Pal R, Janas A, Ferrazzano P, Farias-Moeller R, Snooks KC, Chang CCH, Iolster T, Erklauer JC, Jorro Baron F, Wassmer E, Yoong M, Jardine M, Mohammad Z, Deep A, Kendirli T, Lidsky K, Dallefeld S, Flockton H, Agrawal S, Siruguppa KS, Waak M, Gutiérrez-Mata A, Butt W, Bogantes-Ledezma S, Sevilla-Acosta F, Umaña-Calderón A, Ulate-Campos A, Yock-Corrales A, Talisa VB, Kanthimathinathan HK, Schober ME, Fink EL. Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity. JAMA Netw Open 2024; 7:e2414122. [PMID: 38857050 PMCID: PMC11165382 DOI: 10.1001/jamanetworkopen.2024.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/20/2024] [Indexed: 06/11/2024] Open
Abstract
Importance Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
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Affiliation(s)
- Conall Francoeur
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Alicia M. Alcamo
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Courtney L. Robertson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark S. Wainwright
- Division of Pediatric Neurology, University of Washington, Seattle Children’s Hospital, Seattle
| | - Juan D. Roa
- Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, Colombia
- Department of Pediatric Neurology, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Marlina E. Lovett
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Casey Stulce
- Department of Pediatrics, The University of Chicago, Chicago, Illinois
| | - Mais Yacoub
- Division of Critical Care, Department of Pediatrics, University Medical Center Children’s Hospital, Las Vegas, Nevada
| | - Renee M. Potera
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth Zivick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston
| | - Adrian Holloway
- Division of Critical Care, Department of Pediatrics, University of Maryland Medical Center, Baltimore
| | - Ashish Nagpal
- Department of Pediatrics, Section of Critical Care Medicine, Oklahoma Children’s Hospital at Oklahoma University Health, College of Medicine, The University of Oklahoma Health Sciences, Oklahoma City
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Department of Pediatrics, Carver College of Medicine, University of Iowa Health Care, Iowa City
| | - Katelyn M. Even
- Division of Pediatric Critical Care Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey
| | | | | | - Stephanie P. Schwartz
- Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill
| | - Tracie C. Walker
- Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill
| | | | - Leslie A. Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Andrew S. Geneslaw
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Taylor B. Sewell
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Patrice Pryce
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Wendy G. Silver
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jieru E. Lin
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Wendy S. Vargas
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Alexis Topjian
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jennifer L. McGuire
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jesus Angel Domínguez Rojas
- Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru
| | - Jaime Tasayco-Muñoz
- Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru
| | - Sue J. Hong
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William J. Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Doerfler
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Department of Pediatrics, Oregon Health & Science University, Portland
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kurt Drury
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Dhristie Bhagat
- Department of Neurology, New York University Langone Health, New York
| | - Aaron Nelson
- Department of Neurology, New York University Langone Health, New York
| | - Dana Price
- Department of Neurology, New York University Langone Health, New York
| | - Heda Dapul
- Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children’s Hospital, New York University Langone Health, New York
| | - Laura Santos
- Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children’s Hospital, New York University Langone Health, New York
| | - Robert Kahoud
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Brian Appavu
- Division of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, The University of Arizona, College of Medicine, Phoenix
| | - Kristin P. Guilliams
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shannon C. Agner
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Karen H. Walson
- Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Lindsey Rasmussen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Standford University Medicine, Lucile Packard Children’s Hospital Stanford, Stanford, California
| | - Ria Pal
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna Janas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Standford University Medicine, Lucile Packard Children’s Hospital Stanford, Stanford, California
| | - Peter Ferrazzano
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Raquel Farias-Moeller
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee
| | - Kellie C. Snooks
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee
| | - Chung-Chou H. Chang
- Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tomás Iolster
- Department of Pediatrics, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Jennifer C. Erklauer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston
| | - Facundo Jorro Baron
- Department of Pediatrics, Hospital General de Niños Pedro Elizade, Buenos Aires, Argentina
| | - Evangeline Wassmer
- Birmingham Children’s Hospital, Birmingham, United Kingdom
- Aston Institute of Health and Neurodevelopment, Birmingham, United Kingdom
- Aston University, Birmingham, United Kingdom
| | - Michael Yoong
- Department of Neurology, Royal London Children’s Hospital, London, United Kingdom
| | - Michelle Jardine
- Pediatric Critical Care Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Zoha Mohammad
- Pediatric Intensive Care Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Akash Deep
- Department of Women and Children’s Health, King’s College Hospital, London, United Kingdom
| | - Tanil Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Karen Lidsky
- Division of Pediatric Critical Care Medicine, Wolfson Children’s Hospital, Jacksonville, Florida
| | | | - Helen Flockton
- Paediatric Critical Care Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Shruti Agrawal
- Paediatric Intensive Care Unit, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Krishna Sumanth Siruguppa
- Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco
- Fresno Medical Education and Research Program, Department of Medicine, University of California, San Francisco, Fresno
- Department of Pediatrics, Community Medical Centers, Fresno, California
| | - Michaela Waak
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Alfonso Gutiérrez-Mata
- Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica
| | - Warwick Butt
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, The Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sixto Bogantes-Ledezma
- Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica
| | | | - Andres Umaña-Calderón
- Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica
| | - Adriana Ulate-Campos
- Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Emergency Service, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica
| | - Victor Brodzik Talisa
- Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hari Krishnan Kanthimathinathan
- West Midlands Regional Genetics Laboratory, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Michelle E. Schober
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Fischer M, Ngendahimana DK, Watson RS, Schwarz AJ, Shein SL. Cognitive, Functional, and Quality of Life Outcomes 6 Months After Mechanical Ventilation for Bronchiolitis: A Secondary Analysis of Data From the Randomized Evaluation of Sedation Titration for Respiratory Failure Trial ( RESTORE ). Pediatr Crit Care Med 2024; 25:e129-e139. [PMID: 38038620 DOI: 10.1097/pcc.0000000000003405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To describe rates and associated risk factors for functional decline 6 months after critical bronchiolitis in a large, multicenter dataset. DESIGN Nonprespecified secondary analysis of existing 6-month follow-up data of patients in the Randomized Evaluation of Sedation Titration for Respiratory Failure trial ( RESTORE , NCT00814099). SETTING Patients recruited to RESTORE in any of 31 PICUs in the United States, 2009-2013. PATIENTS Mechanically ventilated PICU patients under 2 years at admission with a primary diagnosis of bronchiolitis. INTERVENTIONS There were no interventions in this secondary analysis; in the RESTORE trial, PICUs were randomized to protocolized sedation versus usual care. MEASUREMENTS AND MAIN RESULTS "Functional decline," defined as worsened Pediatric Overall Performance Category and/or Pediatric Cerebral Performance Category (PCPC) scores at 6 months post-PICU discharge as compared with preillness baseline. Quality of life was assessed using Infant Toddler Quality of Life Questionnaire (ITQOL; children < 2 yr old at follow-up) or Pediatric Quality of Life Inventory (PedsQL) at 6 months post-PICU discharge. In a cohort of 232 bronchiolitis patients, 28 (12%) had functional decline 6 months postdischarge, which was associated with unfavorable quality of life in several ITQOL and PedsQL domains. Among 209 patients with normal baseline functional status, 19 (9%) had functional decline. In a multivariable model including all subjects, decline was associated with greater odds of worse baseline PCPC score and longer PICU length of stay (LOS). In patients with normal baseline status, decline was also associated with greater odds of longer PICU LOS. CONCLUSIONS In a random sampling of RESTORE subjects, 12% of bronchiolitis patients had functional decline at 6 months. Given the high volume of mechanically ventilated patients with bronchiolitis, this observation suggests many young children may be at risk of new morbidities after PICU admission, including functional and/or cognitive morbidity and reduced quality of life.
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Affiliation(s)
- Meredith Fischer
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - R Scott Watson
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Adam J Schwarz
- Department of Pediatrics, Critical Care Division, CHOC Children's Hospital, Orange, CA
| | - Steven L Shein
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
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Tang M, Zhang H, Liu X, Li N, Sun X, Zhang X. Quality of Life Among Chinese Child Survivors of Heart Failure After Discharge From Pediatric Intensive Care Unit. J Pediatr Health Care 2024; 38:e1-e6. [PMID: 37855782 DOI: 10.1016/j.pedhc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/24/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION This study investigated the current quality of life (QOL) status and related influencing factors in children with heart failure in the pediatric intensive care unit (PICU). METHOD One hundred eighty-three children admitted to the PICU with heart failure were consecutively sampled. They were assessed 3 months after discharge and compared with a control group of 160 healthy individuals. The Pediatric Quality of Life Inventory (version 4.0) and Children's Revised Impact of Event Scale were completed, and factors influencing QOL were analyzed. RESULTS Three months after discharge, the PICU group reported lower average scores on the overall QOL and the physical and emotional functioning scales than the control group. In particular, posttraumatic stress disorder status, age, and caregiver educational level greatly influenced the PICU children's QOL. DISCUSSION More interventions and attention are needed to improve the QOL for PICU heart failure patients after discharge.
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Bhadani KH, Sankar J, Datta SK, Tungal S, Jat KR, Kabra SK, Lodha R. Validation of a Clinical Tool to Predict Neurological Outcomes in Critically Ill Children-A Prospective Observational Study. Indian J Pediatr 2024; 91:10-16. [PMID: 36949369 DOI: 10.1007/s12098-023-04482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/09/2022] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To evaluate the performance of the empiric tool by Gupta et al. in predicting neurological outcomes in children admitted to the pediatric intensive care unit (PICU) and to evaluate the association of biomarkers S100B and NSE with neurological outcomes. METHODS This prospective observational study was conducted in 163 critically ill children aged 2 mo to 17 y admitted to the PICU from June 2020 to July 2021. The authors used the prediction tool developed by Gupta et al.; the tool was applied at admission and at PICU discharge/death. Samples for NSE and S100B were collected at admission and discharge. The performance of the new tool was assessed through discrimination and calibration. Risk factors for "unfavorable outcomes" (decline in PCPC score by > 1) were evaluated by multivariate analysis. RESULTS The PICU mortality was 28% (n = 45). When the tool developed by Gupta et al. was used at the time of admission, favorable neurological outcomes were predicted for 69% (112) children. The area under the curve for the new tool at admission was 0.72 and at discharge/death it was 0.99, and the calibration was excellent at both time points. Independent factors associated with unfavorable neurological outcomes were higher PCPC scores and organ failure. As the number of samples processed for NSE and S100B was less, statistical analysis was not attempted. CONCLUSIONS The new tool by Gupta et al. has good discrimination, calibration, sensitivity, and specificity and can be used as a prediction tool. NSE and S100B are promising biomarkers and need further evaluation.
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Affiliation(s)
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Sudip Kumar Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Tungal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Gill I, Davidson SA, Stevenson PG, Robinson R, Pool D, Valentine J. Outcomes following intensive day rehabilitation for young people in Western Australia. J Pediatr Rehabil Med 2024; 17:167-178. [PMID: 38108363 PMCID: PMC11307091 DOI: 10.3233/prm-220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/05/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Intensive rehabilitation aims to improve and maintain functioning in young people who experience disability due to illness or injury. Day rehabilitation may have advantages for families and healthcare systems over inpatient models of rehabilitation. METHODS This study evaluated the goals and outcomes of a cohort of young people in Western Australia who attended a specialist intensive day rehabilitation programme ("iRehab") at Perth Children's Hospital. Analysis of the iRehab service database was performed. Rehabilitation goals and outcomes were recorded as per the Canadian Occupational Performance Measure (COPM), Children's Functional Independence Measure (WeeFIM), and Goal Attainment Scale (GAS). RESULTS There were 586 iRehab admissions between August 11, 2011, and December 31, 2018. Admissions were divided by diagnosis: Cerebral Palsy (228, 38.5%), Acquired Brain Injury (125, 21.3%), Spinal Cord Disorders (91, 15.5%), and Other (141, 24.2%). Mean COPM Performance increased by 2.78 points from admission to discharge (95% CI 2.58 to 2.98, p < 0.001). Mean COPM Satisfaction was 3.29 points higher at discharge than admission (95% CI 3.07 to 3.51, p < 0.001). Mean total WeeFIM score improved by 6.51 points between admission and discharge (95% CI 5.56 to 7.45, p < 0.001), and by 3.33 additional points by six months post discharge (95% CI 2.14 to 4.53, p < 0.001). Mean GAS T-scores increased by 27.85 (95% CI 26.73 to 28.97, p < 0.001) from admission to discharge, and by 29.64 (95% CI 28.26 to 31.02, p < 0.001) from admission to six months post discharge, representing improvement consistent with team expectations. CONCLUSION This study describes a model by which intensive rehabilitation can be delivered in a day rehabilitation setting. A diverse population of young people who experienced disability achieved significant improvements in occupational performance, independence, and goal attainment after accessing intensive day rehabilitation. Improvements were measured in all diagnostic subgroups and were maintained six months after discharge.
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Affiliation(s)
- Irwin Gill
- Kids Rehab WA, Perth Children’s Hospital, Perth, Australia
| | | | - Paul G. Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Rae Robinson
- Kids Rehab WA, Perth Children’s Hospital, Perth, Australia
| | - Dayna Pool
- Kids Rehab WA, Perth Children’s Hospital, Perth, Australia
| | - Jane Valentine
- Kids Rehab WA, Perth Children’s Hospital, Perth, Australia
- Curtin University, Perth, Australia
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8
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Rogers T, Stram D, Fort V, Wang X, Weintraub MR, Wong V, Boshuizen V. Pediatric Intensive Care Unit Early Mobility Program: Impact on Patient Functional Status. Perm J 2023; 27:25-35. [PMID: 37695848 PMCID: PMC10723098 DOI: 10.7812/tpp/23.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Patients admitted to the pediatric Intensive Care Unit (PICU) are frequently sedated, restrained, and placed on bed rest. These practices have known negative impacts including prolonged hospital stay and diminished functional status after discharge. The authors' objective was to investigate the impact of a PICU early mobility protocol on the frequency of orders for physical, occupational, and speech therapy (PT, OT, ST) and improvement in patient functional status. METHODS Patients admitted in 2019 prior to the development of the PICU early mobility protocol were compared to those admitted in 2020 who underwent the protocol. Differences in clinical characteristics; PICU length of stay; rates of PT, OT, and ST orders; rates of bedside mobility activities; and functional status scores (FSSs) were assessed in bivariate and multivariate analyses. The protocol included early PT, OT, and ST order placement and frequent in-room mobility activities. RESULTS Of the 384 patients included in the study, 216 (56%) were preprotocol patients, and 168 (44%) underwent the protocol. Patients in 2020 were more likely to receive a physical therapy order compared to their 2019 counterparts (79% vs 47%, p < 0.001). Patients in 2020 had a higher daily incidence of mobility activities compared to those in 2019 (4.88 activities vs 4.1 activities, p < 0.001). Changes in functional status scores were similar between the 2 groups. CONCLUSION PICU early mobility was associated with increased physical, occupational, and speech therapy orders and daily mobility activities but was not associated with a reduction in functional morbidity at discharge or 3 months post-discharge.
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Affiliation(s)
- Timothy Rogers
- Pediatric Intensive Care Unit, Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Douglas Stram
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Victoria Fort
- Pediatric Residency, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Xing Wang
- Pediatric Residency, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Vanessa Wong
- Pediatric Residency, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Vanessa Boshuizen
- Pediatric Residency, Kaiser Permanente Northern California, Oakland, CA, USA
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9
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Atkinson TB, Forsyth RJ. It's easier to relearn gross motor skills than learn them for the first time after injury: Empirical evidence informing the age at injury debate. Eur J Paediatr Neurol 2023; 47:67-71. [PMID: 37741169 DOI: 10.1016/j.ejpn.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
The effect of age at injury on outcomes after brain injury has long been debated. Many have argued that the greater plasticity of the immature brain aids in its recovery from trauma, but others (notably Donald Hebb) have argued that early injury can impair the future ability of the brain to acquire new capabilities. This is difficult to assess empirically due to the presence of many age-dependent confounders. We performed Item Response Theory (IRT) analyses of two datasets of Gross Motor Function Measure (GMFM) observations, one in children with cerebral palsy (CP) and one in children with acquired brain injury (ABI) sustained at later ages. We used IRT to derive independent estimates of test item difficulty in the two populations. Additionally, where comparison between GMFM items and items in the Denver II Developmental Screening Test battery was possible we used the latter to obtain the ages at which these abilities are acquired in typically developing children. Item difficulty estimates for the two populations are highly correlated (adjusted r2=0.89, p<0.0005), but demonstrate significant bias with harder items (typically acquired at later ages) being more readily achieved by children with ABI compared to CP. These results support the Hebbian perspective that (when considering gross motor function) it is easier to maintain or recover previously established functions than to learn them for the first time in an injured brain. This argues for a more cautious outcome prognosis in injury at very young ages.
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Affiliation(s)
| | - Rob J Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Reddy AR, Stinson HR, Alcamo AM, Pinto NP, Fitzgerald JC. Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions. Risk Manag Healthc Policy 2023; 16:1881-1891. [PMID: 37736598 PMCID: PMC10511018 DOI: 10.2147/rmhp.s394458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
Pediatric sepsis is a leading cause of morbidity and mortality in children globally. Children who require the pediatric intensive care unit (PICU) are at high risk for new or worsening co-morbidities, as well as readmission. This review describes the current state of protocolized follow-up after pediatric sepsis requiring PICU admission. We searched Medline and EMBASE databases for studies published in English from 2005 to date. Duplicates, review articles, abstracts and poster presentations were excluded; neonatal intensive care unit (NICU) patients were also excluded since neonatal sepsis is variably defined and differs from the pediatric consensus definition. The search yielded 418 studies of which 55 were duplicates; the subsequent 363 studies were screened for inclusion criteria, yielding 31 studies for which full article screening was completed. Subsequently, 23 studies were excluded due to wrong population (9), wrong publication type (10), duplicate data (3) or wrong outcome (1). In total, nine studies were included for which we described study design, setting, population, sample size, outcomes, PICU core outcome domain, and results. There were 4 retrospective cohort studies, 4 prospective cohort studies, 1 retrospective case series and no prospective trials. These studies show the varying trajectories of recovery after discharge, with the common finding that new or worsening morbidities are worse within months of discharge, but may persist. Sepsis survivors may have distinct needs and a different post-PICU trajectory compared to other critically ill children, particularly in quality of life and neurocognitive outcomes. Future research should focus on developing screening protocols and studying protocolized follow-up trials to reduce morbidity after pediatric sepsis.
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Affiliation(s)
- Anireddy R Reddy
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hannah R Stinson
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alicia M Alcamo
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neethi P Pinto
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julie C Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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de Sonnaville ESV, Kӧnigs M, Aarnoudse-Moens CSH, van Woensel JBM, Oosterlaan J, Knoester H. Long-Term Follow-Up of Daily Life Functioning After Pediatric Intensive Care Unit Admission. J Pediatr 2023; 260:113477. [PMID: 37187287 DOI: 10.1016/j.jpeds.2023.113477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the long-term impact of pediatric intensive care unit (PICU) admission on daily life functioning while exploring the potential mediating role of neurocognitive outcome. STUDY DESIGN This cross-sectional observational study compared children aged 6-12 years with previous PICU admission (age ≤1 year) for bronchiolitis requiring mechanical ventilation ("patient group," n = 65) to demographically comparable healthy peers ("control group," n = 76). The patient group was selected because bronchiolitis is not expected to affect neurocognitive functioning in itself. Assessed daily life outcome domains were behavioral and emotional functioning, academic performance, and health-related quality of life (QoL). The role of neurocognitive outcomes in the relationship between PICU admission and daily life functioning was assessed by mediation analysis. RESULTS The patient group did not differ from the control group regarding behavioral and emotional functioning but performed poorer on academic performance and school-related QoL (Ps ≤ .04, d = -0.48 to -0.26). Within the patient group, lower full-scale IQ (FSIQ) was associated with poorer academic performance and school-related QoL (Ps ≤ .02). Poorer verbal memory was associated with poorer spelling performance (P = .002). FSIQ mediated the observed effects of PICU admission on reading comprehension and arithmetic performance. CONCLUSIONS Children admitted to the PICU are at risk for long-term adverse daily life outcomes in terms of academic performance and school-related QoL. Findings suggest that lower intelligence may contribute to academic difficulties after PICU admission. Findings underline the importance of monitoring daily life and neurocognitive functioning after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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12
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de Sonnaville ESV, van Woensel JBM, van Goudoever JB, Otten MH, Teela L, Aarnoudse-Moens CSH, Terheggen-Lagro SWJ, van der Hulst AE, Engelen M, Kӧnigs M, Oosterlaan J, Knoester H. Structured Multidisciplinary Follow-Up After Pediatric Intensive Care: A Model for Continuous Data-Driven Health Care Innovation. Pediatr Crit Care Med 2023; 24:484-498. [PMID: 36807306 PMCID: PMC10226472 DOI: 10.1097/pcc.0000000000003213] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. DESIGN Prospective observational cohort study. SETTING Outpatient PICU follow-up clinic. PATIENTS Patients 0-18 years old admitted to our PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In our structured multidisciplinary follow-up program, follow-up care is provided by a pediatric intensivist and psychologist and in addition, depending on patient's critical illness and received PICU treatment(s), by a pediatric pulmonologist, cardiologist, neurologist, and/or neuropsychologist. All consultations are scheduled consecutively. Collected data are stored in a hospital-wide data warehouse and used for yearly health care evaluation sessions as well as scientific research. Challenges in organizing this follow-up program include technological challenges, providing time-efficient care, participation rate, and completeness of questionnaires. In our experience, a dedicated team is essential to tackle these challenges. Our first results, obtained in 307 of 388 referred patients (79.1%), showed the diversity of problems arising after PICU discharge, including physical, neurocognitive, and psychosocial sequelae. In addition, our data also reflected the risk of psychosocial problems among parents. Within the limited operation time of our follow-up program, the program has evolved based on our experiences and the data collected. CONCLUSIONS We successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke H Otten
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lorynn Teela
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Pulmonology and Allergy, Amsterdam Reproduction and Development & Infection and Immunity Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annelies E van der Hulst
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Engelen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam Neuroscience & Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Dannenberg VC, Rovedder PME, Carvalho PRA. Long-term functional outcomes of children after critical illnesses: A cohort study. Med Intensiva 2023; 47:280-288. [PMID: 36344345 DOI: 10.1016/j.medine.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/17/2022] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. DESIGN Ambispective cohort study. SETTING Pediatric intensive care unit (PICU) in a tertiary academic center. PARTICIPANTS Children (1 month-17-year-old) and their caregivers. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic, clinical, and functional status. RESULTS Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02-16.72; p=0.04), and 4.76 (CI 95% 1.19-19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. CONCLUSION This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children.
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Affiliation(s)
- V C Dannenberg
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
| | - P M E Rovedder
- Escola de Educação Física, Fisioterapia e Dança, (ESEFID), Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - P R A Carvalho
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Hospital de Clínicas de Porto Alegre, Brazil
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14
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Long DA, Waak M, Doherty NN, Dow BL. Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121938. [PMID: 36553381 PMCID: PMC9776953 DOI: 10.3390/children9121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children's brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3138-3834
| | - Michaela Waak
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Nicola N. Doherty
- Regional Trauma Network, SPPG, DOH, Belfast BT2 8BS, Northern Ireland, UK
- School of Psychology, Faculty of Life and Health Sciences, Coleraine Campus, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Belinda L. Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
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15
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Mobilization of Children with External Ventricular Drains: A Retrospective Cohort Study. CHILDREN 2022; 9:children9111777. [DOI: 10.3390/children9111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
The implementation of early mobility programs for children with critical illnesses has been growing. Children with acute neurologic conditions that result in the requirement of an external ventricular drain (EVD) may be excluded from attaining the benefits of early mobility programs due to the fear of adverse events. The purpose of this study was to examine the implementation, safety, and outcomes of children with EVDs mobilized by physical therapists. A single-site retrospective cohort study of children with EVDs mobilized by physical therapy (PT) was conducted. Patients aged 3–21 years who were hospitalized from September 2016 to December 2020 were included in this study. Results: Out of a total of 192 electronic health records with EVDs, 168 patients (87.5%) participated in 1601 early mobilization encounters led by physical therapists. No adverse events occurred due to mobilization. Patients mobilized more frequently by PT had a higher level of activity at discharge (p = 0.014), a shorter length of stay (p = 0.001), and a more favorable discharge (p = 0.03). The early mobilization of children with EVDs can be implemented safely without adverse events. Patients mobilized with an EVD are more functional at discharge, spend fewer days in the hospital, and have a more favorable discharge compared to those who do not receive PT.
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16
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Sobotka SA, Lynch EJ, Dholakia AV, Mayampurath A, Pinto NP. PICU Survivorship: Factors Affecting Feasibility and Cohort Retention in a Long-Term Outcomes Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1041. [PMID: 35884025 PMCID: PMC9317147 DOI: 10.3390/children9071041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Our understanding of longitudinal outcomes of Pediatric Intensive Care Unit (PICU) survivors is limited by the heterogeneity of follow-up intervals, populations, and outcomes assessed. We sought to demonstrate (1) the feasibility of longitudinal multidimensional outcome assessment and (2) methods to promote cohort retention. The objective of this presented study was to provide details of follow-up methodology in a PICU survivor cohort and not to present the outcomes at long-term follow-up for this cohort. We enrolled 152 children aged 0 to 17 years admitted to the PICU in a prospective longitudinal cohort study. We examined resource utilization, family impact of critical illness, and neurodevelopment using the PICU Outcomes Portfolio (POP) Survey which included a study-specific survey and validated tools: 1. Functional Status Scale, 2. Pediatric Evaluation of Disability Inventory Computer Adaptive Test, 3. Pediatric Quality of Life Inventory, 4. Strengths and Difficulties Questionnaire, and 5. Vanderbilt Assessment Scales for Attention Deficit-Hyperactivity Disorder. POP Survey completion rates were 89%, 78%, and 84% at 1, 3, and 6 months. Follow-up rates at 1, 2, and 3 years were 80%, 55%, and 43%. Implementing a longitudinal multidimensional outcome portfolio for PICU survivors is feasible within an urban, tertiary-care, academic hospital. Our attrition after one year demonstrates the long-term follow-up challenges in this population. Our findings inform ongoing efforts to implement core outcome sets after pediatric critical illness.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Emma J. Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Ayesha V. Dholakia
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Anoop Mayampurath
- Department of Biostatistics & Medical Informatics, The University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Neethi P. Pinto
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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Vanhorebeek I, Jacobs A, Mebis L, Dulfer K, Eveleens R, Van Cleemput H, Wouters PJ, Verlinden I, Joosten K, Verbruggen S, Van den Berghe G. Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial. Crit Care 2022; 26:133. [PMID: 35549984 PMCID: PMC9097055 DOI: 10.1186/s13054-022-04010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many critically ill children face long-term developmental impairments. The PEPaNIC trial attributed part of the problems at the level of neurocognitive and emotional/behavioral development to early use of parenteral nutrition (early-PN) in the PICU, as compared with withholding it for 1 week (late-PN). Insight in long-term daily life physical functional capacity after critical illness is limited. Also, whether timing of initiating PN affects long-term physical function of these children remained unknown. Methods This preplanned follow-up study of the multicenter PEPaNIC randomized controlled trial subjected 521 former critically ill children (253 early-PN, 268 late-PN) to quantitative physical function tests 4 years after PICU admission in Leuven or Rotterdam, in comparison with 346 age- and sex-matched healthy children. Tests included handgrip strength measurement, timed up-and-go test, 6-min walk test, and evaluation of everyday overall physical activity with an accelerometer. We compared these functional measures for the former critically ill and healthy children and for former critically ill children randomized to late-PN versus early-PN, with multivariable linear or logistic regression analyses adjusting for risk factors. Results As compared with healthy children, former critically ill children showed less handgrip strength (p < 0.0001), completed the timed up-and-go test more slowly (p < 0.0001), walked a shorter distance in 6 min (p < 0.0001) during which they experienced a larger drop in peripheral oxygen saturation (p ≤ 0.026), showed a lower energy expenditure (p ≤ 0.024), performed more light and less moderate physical activity (p ≤ 0.047), and walked fewer steps per day (p = 0.0074). Late-PN as compared with early-PN did not significantly affect these outcomes. Conclusions Four years after PICU admission, former critically ill children showed worse physical performance as compared with healthy children, without impact of timing of supplemental PN in the PICU. This study provides further support for de-implementing the early use of PN in the PICU. Trial registration ClinicalTrials.gov, NCT01536275; registered on February 22, 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04010-3.
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Affiliation(s)
- Ilse Vanhorebeek
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - An Jacobs
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Liese Mebis
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Karolijn Dulfer
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Renate Eveleens
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanna Van Cleemput
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pieter J Wouters
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ines Verlinden
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Koen Joosten
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sascha Verbruggen
- Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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18
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Bhalla A. The Kids Are Not Okay: Healthcare Utilization After Critical Illness. Pediatr Crit Care Med 2022; 23:334-337. [PMID: 35485499 PMCID: PMC9060346 DOI: 10.1097/pcc.0000000000002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anoopindar Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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19
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Dannenberg V, Rovedder P, Carvalho P. Long-term functional outcomes of children after critical illnesses: A cohort study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Ravikumar N, Sankar J, Das RR. Functional Outcomes in Survivors of Pediatric Sepsis: A Scoping Review and Discussion of Implications for Low- and Middle-Income Countries. Front Pediatr 2022; 10:762179. [PMID: 35345613 PMCID: PMC8957211 DOI: 10.3389/fped.2022.762179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pediatric sepsis is an important cause of mortality and morbidity in low- and middle-income countries (LMIC), where there is a huge burden of infectious diseases. Despite shortage of resources, adapting protocol-based care has reduced sepsis-related deaths but survivors of pediatric sepsis are at risk of poor functional outcomes. OBJECTIVES To perform a scoping review of the literature on functional outcomes of pediatric sepsis survivors after discharge from the intensive care unit (ICU) and discuss the implications for patients in LMICs. The outcomes include prevalence of survival with reduced functional outcomes or quality of life (QoL) and changes over time during follow-up or recovery, and these outcomes were compared with other groups of children. METHODS We searched major medical electronic databases for relevant literature from January 2005 until November 2021, including Medline (via PubMed), Embase, CINAHL, and Google Scholar databases. We included observational studies and follow-up data from clinical trials involving children/adolescents (≤18 years) who were admitted to pediatric intensive care unit (PICU) and got discharged finally. Major focus was on survivors of sepsis in LMIC. We followed PRISMA guidelines for scoping reviews (PRISM-ScR). RESULTS We included eight papers reporting data of functional outcomes in 2,915 children (males = 53%, and comorbidity present in 56.6%). All included studies were either a prospective or retrospective cohort study. Studies were classified as Level II evidence. Disabilities affecting physical, cognitive, psychological, and social function were reported in children following discharge. Overall disability reported ranged between 23 and 50% at hospital discharge or 28 days. Residual disability was reported at 1, 3, 6, and 12 months of follow-up with an overall improving trend. Failure to recover from a baseline HRQL on follow-up was seen in one-third of survivors. Organ dysfunction scores such as pSOFA, PeLOD, vasoactive inotrope score, neurological events, immunocompromised status, need for CPR, and ECMO were associated with poor functional outcome. CONCLUSIONS The research on functional outcomes in pediatric sepsis survivors is scarce in LMIC. Measuring baseline and follow-up functional status, low-cost interventions to improve management of sepsis, and multidisciplinary teams to identify and treat disabilities may improve functional outcomes.
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Affiliation(s)
- Namita Ravikumar
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
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21
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Post-Intensive Care Syndrome in Children: A Concept Analysis. J Pediatr Nurs 2021; 61:417-423. [PMID: 34687989 DOI: 10.1016/j.pedn.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022]
Abstract
PROBLEM Post-intensive care syndrome in paediatrics (PICS-p) is a term used to describe newly acquired or worsened impairment in one or more aspects of a child's physical, psychological, cognitive, and social functioning after discharge from the paediatric intensive care unit (PICU). However, consensus, conceptual insights, and assessment guidance are lacking for this syndrome. Therefore, this analysis aimed to define the concept of PICS-p to help practitioners and researchers understand the syndrome in detail using the Walker and Avant approach. ELIGIBILITY CRITERIA We reviewed studies retrieved from several databases, namely PubMed, Google Scholar, Web of Science, Ovid, ScienceDirect, and the Springer database, using the following keywords: 'post-intensive care syndrome', 'PICU', 'children', 'PICS-p', and 'concept analysis'. Both quantitative and qualitative studies on PICS-p were included in the search. The articles were limited to those published up to November 21, 2020. SAMPLE Of the 762 publications selected, 24 publications met the inclusion criteria. RESULTS PICS-p is defined on the basis of the following aspects: (1) Physical dysfunction; (2) Cognitive dysfunction; (3) Psychological dysfunction; and (4) Social dysfunction. CONCLUSION With the increasing success rate of PICU treatment, reduced case fatality is no longer the only outcome of critical illness in children. The long-term outcomes in children discharged from hospitals have attracted attention from families, hospitals, and communities. IMPLICATIONS A clear definition of PICS-p will help medical staff understand PICS-p in detail and provide a theoretical basis for the diagnosis and treatment of this syndrome.
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22
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Lee LA, Moss SJ, Martin DA, Rosgen BK, Wollny K, Gilfoyle E, Fiest KM. Comfort-holding in critically ill children: a scoping review. Can J Anaesth 2021; 68:1695-1704. [PMID: 34405358 PMCID: PMC8370455 DOI: 10.1007/s12630-021-02090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs). SOURCES This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate. PRINCIPAL FINDINGS Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding. CONCLUSION There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention.
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Affiliation(s)
- Laurie A Lee
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada.
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dori-Ann Martin
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada
- Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Elaine Gilfoyle
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Pediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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24
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Morrow BM. Building a culture of early mobilization in the pediatric intensive care unit-a nuts and bolts approach. Transl Pediatr 2021; 10:2845-2857. [PMID: 34765506 PMCID: PMC8578759 DOI: 10.21037/tp-20-324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
The culture of sedation and immobilization in the pediatric intensive care unit (PICU) is associated with PICU-acquired weakness, delirium, and poor functional, neurocognitive and psychosocial outcomes. A structured approach to introducing physical activity, as early as possible after PICU admission, may prevent these complications and optimize the holistic outcomes of critically ill children. Changing culture and introducing new clinical practice in PICU is complex, but can be approached systematically, using a "nuts and bolts" approach targeting the basic, practical considerations and essential required elements or components. Extending the construction analogy, this article reviews the relevant literature to describe the essential elements required to build and sustain a successful and safe early mobility program in the PICU. Effective early mobilization requires individual patient assessment and goal setting, using a collaborative inter-disciplinary, patient- and family-centered approach, to ensure mobility goals and physical activities are appropriate for the patient's age, condition/s, premorbid function, strength, endurance and developmental level. Early mobility activities for the pediatric age spectrum include active or active-assisted range of motion exercises, neurodevelopmental play, use of mobility devices, in-bed exercises, transfers, sitting or standing tolerance, crawling, pre-gait activities, ambulation and activities of daily living, with a focus on play as function. Although there are few complete contraindications to early mobilization, appropriate precautions and preparation should be taken to mitigate potential safety concerns. Although there are many perceived barriers to early mobilization in the PICU, at the level of patient, provider, institution and knowledge translation; these are not objectively associated with increased risk during mobilization and can be overcome through an engaged process of practice change by all members of the interprofessional clinical team. Early mobility programs could be initiated in PICU as systematic quality improvement initiatives, with established processes to optimize structural, process and system elements and to provide continual feedback, measurement, benchmarking and collaboration; to ultimately impact on measurable patient outcomes. Early, graded, and individually prescribed mobilization should be considered as part of the standard PICU "package of care" for all critically ill and injured children, in order to improve their functional status and quality of life after PICU discharge.
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Affiliation(s)
- Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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25
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Dumas CM, Grajo LC. The Content Validity and Inter-Rater Reliability of the Occupational Therapy Pediatric Inventory of Cognitive Skills (OT-PICS): An Assessment Tool of Functional Cognition in Children. Occup Ther Health Care 2021; 36:84-100. [PMID: 34473001 DOI: 10.1080/07380577.2021.1972381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Occupational Therapy Pediatric Inventory of Cognitive Skills (OT-PICS) is being developed to evaluate functional cognition skills in children in the domains of play, educational participation, and self-care. This study aimed to determine the content validity and inter-rater reliability of the OT-PICS. Seven content experts agreed that all 15 items of the tool are essential items to examine functional cognition in children (k = 0.71-1.0; I-CVI = 0.71-1.0; S-CVI = 0.96. The OT-PICS also has moderate reliability (ICC = 0.63) between nine trained raters. The tool was then revised and refined for clarity based on therapist's comments and feedback.
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Affiliation(s)
- Christina M Dumas
- Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lenin C Grajo
- Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
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26
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Thompson S, Cassidy C, McKibbon S, Sangster M, Foster J. Barriers and enablers to the development and implementation of early mobility programs for children in the pediatric intensive care unit: a scoping review protocol. JBI Evid Synth 2021; 19:1735-1741. [PMID: 33851943 DOI: 10.11124/jbies-20-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to gather and map the current literature associated with barriers and enablers related to the development and implementation of an early mobility program in pediatric intensive care units. INTRODUCTION As care for critically ill patients has evolved, strategies to optimize patient outcomes and reduce the side effects of treatment have become a rising priority for clinicians, patients, and their families. Early mobilization of patients with critical illness is the only evidence-based intervention that decreases intensive care unit-acquired weakness; it may also minimize intensive care unit-acquired delirium. Early mobility in the pediatric setting has many obstacles, and routine uptake of early mobility practice has lagged. INCLUSION CRITERIA This review will consider literature related to the barriers and enablers to the development and/or implementation of early mobility programs in pediatric intensive care units. The review will target programs designed for children and youth from birth to 18 years who have been admitted to a pediatric intensive care unit. METHODS This scoping review will search six databases and several sources of unpublished/gray literature. Studies published in English and French will be included. The search will be restricted to publications after 1980. Data will be extracted using a tool developed by the reviewers. The data extracted will be presented in a tabular manner and highlight the key findings related to the objectives of this review.
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Affiliation(s)
- Shanna Thompson
- Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Christine Cassidy
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformation Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Shelley McKibbon
- Aligning Health Needs and Evidence for Transformation Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,WK Kellogg Health Science Library, Dalhousie University, Halifax, NS, Canada
| | - Michael Sangster
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Professional Practice and Complex Pain, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Foster
- Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada.,Department of Critical Care, Dalhousie University, Halifax, NS, Canada.,Department of Pediatrics, Western University, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
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27
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Skeletal Muscle Changes, Function, and Health-Related Quality of Life in Survivors of Pediatric Critical Illness. Crit Care Med 2021; 49:1547-1557. [PMID: 33861558 DOI: 10.1097/ccm.0000000000004970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe functional and skeletal muscle changes observed during pediatric critical illness and recovery and their association with health-related quality of life. DESIGN Prospective cohort study. SETTING Single multidisciplinary PICU. PATIENTS Children with greater than or equal to 1 organ dysfunction, expected PICU stay greater than or equal to 48 hours, expected survival to discharge, and without progressive neuromuscular disease or malignancies were followed from admission to approximately 6.7 months postdischarge. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Functional status was measured using the Functional Status Scale score and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test. Patient and parental health-related quality of life were measured using the Pediatric Quality of Life Inventory and Short Form-36 questionnaires, respectively. Quadriceps muscle size, echogenicity, and fat thickness were measured using ultrasonography during PICU stay, at hospital discharge, and follow-up. Factors affecting change in muscle were explored. Associations between functional, muscle, and health-related quality of life changes were compared using regression analysis. Seventy-three survivors were recruited, of which 44 completed follow-ups. Functional impairment persisted in four of 44 (9.1%) at 6.7 months (interquartile range, 6-7.7 mo) after discharge. Muscle size decreased during PICU stay and was associated with inadequate energy intake (adjusted β, 0.15; 95% CI, 0.02-0.28; p = 0.030). No change in echogenicity or fat thickness was observed. Muscle growth postdischarge correlated with mobility function scores (adjusted β, 0.05; 95% CI, 0.01-0.09; p = 0.046). Improvements in mobility scores were associated with improved physical health-related quality of life at follow-up (adjusted β, 1.02; 95% CI, 0.23-1.81; p = 0.013). Child physical health-related quality of life at hospital discharge was associated with parental physical health-related quality of life (adjusted β, 0.09; 95% CI, 0.01-0.17; p = 0.027). CONCLUSIONS Muscle decreased in critically ill children, which was associated with energy inadequacy and impaired muscle growth postdischarge. Muscle changes correlated with change in mobility, which was associated with child health-related quality of life. Mobility, child health-related quality of life, and parental health-related quality of life appeared to be interlinked.
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28
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Patel RV, Redivo J, Nelliot A, Eakin MN, Wieczorek B, Quinn J, Gurses AP, Balas MC, Needham DM, Kudchadkar SR. Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up! Pediatr Crit Care Med 2021; 22:e233-e242. [PMID: 33315754 PMCID: PMC8016701 DOI: 10.1097/pcc.0000000000002619] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU. DESIGN A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up! program. Following data saturation, thematic analysis was performed on interview transcripts. SETTING Tertiary-care PICU in the Johns Hopkins Hospital, Baltimore, MD. SUBJECTS Interprofessional PICU staff. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Fifty-two staff members involved in PICU mobilization across multiple disciplines were interviewed. Three constructs emerged that reflected the different stages of PICU Up! program execution: 1) factors influencing the implementation process, 2) staff perceptions of PICU Up!, and 3) improvements in program integration. Themes were developed within these constructs, addressing facilitators for PICU Up! implementation, cultural changes for unitwide integration, positive impressions toward early mobility, barriers to program sustainability, and refinements for more robust staff and family engagement. CONCLUSIONS Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and patient heterogeneity. Characterizing these staff perceptions can facilitate the development of solutions that use institutional strengths to grow and sustain PICU mobility initiatives.
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Affiliation(s)
- Ruchit V. Patel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Juliana Redivo
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Archana Nelliot
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michelle N. Eakin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Beth Wieczorek
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Quinn
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ayse P. Gurses
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michele C. Balas
- Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio
| | - Dale M. Needham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Procter C, Morrow B, Pienaar G, Shelton M, Argent A. Outcomes following admission to paediatric intensive care: A systematic review. J Paediatr Child Health 2021; 57:328-358. [PMID: 33577142 DOI: 10.1111/jpc.15381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
AIM To describe the long-term health outcomes of children admitted to a paediatric intensive care unit. METHODS A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. RESULTS One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. CONCLUSIONS There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.
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Affiliation(s)
- Claire Procter
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Genee Pienaar
- Public Health, Mental Health and Behavioral Sciences, Western Cape Department of Health, Cape Town, South Africa
| | - Mary Shelton
- Reference Librarian, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
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Abstract
OBJECTIVES To evaluate the functional outcomes in critically ill children with severe sepsis using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale and to evaluate the risk factors for "worse outcomes." DESIGN Prospective observational cohort study. SETTING Tertiary care PICU from September 2017 to October 2019. PATIENTS One hundred twenty-one children with severe sepsis, 2 months to 17 years old, admitted to PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores were recorded at admission, PICU discharge, at 3 months and 1 year after discharge. "New disability" was defined as Pediatric Overall Performance Category and Pediatric Cerebral Performance Category score change "from baseline score" by greater than or equal to 1 category. Risk factors for "worse outcomes" (defined as "death" or "new disability") were evaluated by univariate and multivariate analysis. At admission, 33% (n = 39) had mild to moderate "overall disability" (Pediatric Overall Performance Category) and 26% (n = 32) had mild to moderate "cognitive disability" (Pediatric Cerebral Performance Category). At PICU discharge (n = 89 children), 50.5% (n = 45) had "new disability" in overall function (Pediatric Overall Performance Category scores) and 28% (n = 25) had "new disability" in cognitive function (Pediatric Cerebral Performance Category scores). At 3 months follow-up (n = 85 children), "new disability" at PICU discharge improved in 65% (n = 28/43) and 50% (n = 12/24) of those with "overall disability" (Pediatric Overall Performance Category) and "cognitive disability" (Pediatric Cerebral Performance Category), respectively. At 1-year follow-up (n = 84 children), only 5% (n = 2/43) had residual "new disability" in overall function (Pediatric Overall Performance Category) and 14% (n = 3/21) had residual "new disability" in cognitive function. PICU mortality was 26% (n = 32). The proportion with "worse outcomes" was 64% (n = 77). Risk factors for worse outcomes on univariate analysis included higher Pediatric Index of Mortality-3 scores, day 1 pediatric Sequential Organ Failure Assessment score, receiving cardiopulmonary resuscitation during the ICU stay, and treatments received such as ventilation and Vasoactive-Inotrope Score. On multivariate analysis, only day 1 pediatric Sequential Organ Failure Assessment score and receiving cardiopulmonary resuscitation during the ICU stay were found to be statistically significant. CONCLUSIONS Children with severe sepsis had significant "new onset" mild to moderate functional disability at PICU discharge, and most of these children recovered within 1 year after PICU discharge. Day 1 pediatric Sequential Organ Failure Assessment score and patient receiving cardiopulmonary resuscitation during the ICU stay were found to be the significant risk factors of "worse outcomes."
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Young DK, Starace HE, Boddy HI, Connolly KMD, Lock KJ, Hamilton CRE. Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Childhood acquired brain injury is the leading cause of death and long-term disability among children and young people in the UK. Following a childhood brain injury, function is shown to improve within a specialist neurorehabilitation setting. Little evidence currently exists to demonstrate gross motor functional change within an acute hospital setting. The Physical Abilities and Mobility Scale is a valid and reliable outcome measure for use within inpatient paediatric neurorehabilitation following brain injury. The primary aim of this study was to evaluate how the gross motor function of paediatric patients with a new acquired brain injury changes during an acute hospital admission. Methods Data were collected for all patients admitted as an inpatient to one acute hospital over a 12-month period. The Physical Abilities and Mobility Scale was completed at baseline, at least weekly and again at discharge. Views relating to the utility of the Physical Abilities and Mobility Scale were sought among physiotherapists using the measure in order to inform acceptability. Results A total of 28 patients were included in this study. A Wilcoxon signed rank test was performed, which showed a highly significant improvement in function as scored on the Physical Abilities and Mobility Scale between baseline assessment (median 29.00, interquartile range 25.00–35.50) and discharge (median 85.00, interquartile range 75.00–95.00, Z=-4.624, P<0.001). A total of five patients (17.86%) were referred on for specialist residential neurorehabilitation. A post hoc analysis found that the rate of change of the Physical Abilities and Mobility Scale appeared to have an impact on final discharge destination, with slow improvers 18.60 times more likely to require specialist rehabilitation than others. The Physical Abilities and Mobility Scale was found to be acceptable among physiotherapists using it. Conclusions Children with a new acquired brain injury make significant improvements in gross motor function during a period of acute inpatient neurorehabilitation. Further work should look to refine the measure and gain a full understanding of its clinical utilities.
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Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-Intensive-Care Syndrome for the Pediatric Neurologist. Pediatr Neurol 2020; 108:47-53. [PMID: 32299742 PMCID: PMC7306429 DOI: 10.1016/j.pediatrneurol.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.
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Affiliation(s)
- Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Critical care, Oregon Health & Science University
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University
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Ista E, Scholefield BR, Manning JC, Harth I, Gawronski O, Bartkowska-Śniatkowska A, Ramelet AS, Kudchadkar SR. Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU). Crit Care 2020; 24:368. [PMID: 32576273 PMCID: PMC7311184 DOI: 10.1186/s13054-020-02988-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022] Open
Abstract
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. Graphical abstract ![]()
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Affiliation(s)
- Erwin Ista
- Pediatric Intensive Care Unit, Department of Paediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Nursing Science, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Barnaby R Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Paediatric Intensive Care Unit, Birmingham Women & Children's Hospital, Birmingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital & Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Irene Harth
- Pediatric Intensive Care Unit, Universitätsmedizin Mainz, Zentrum für Kinder- und Jugendmedizin, Mainz, Germany
| | - Orsola Gawronski
- Healthcare professional development Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sioshansi PC, Byrne E, Freccero A, Meister KD, Sidell DR. Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study. Laryngoscope 2020; 131:E653-E658. [PMID: 32438519 DOI: 10.1002/lary.28748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study. STUDY DESIGN Multi-institutional survey and prospective cohort study. METHODS Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted. RESULTS Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events. CONCLUSIONS Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E653-E658, 2021.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Eilish Byrne
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Allison Freccero
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
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Williams CN, Eriksson CO, Kirby A, Piantino JA, Hall TA, Luther M, McEvoy CT. Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care. Hosp Pediatr 2020; 9:958-966. [PMID: 31776167 DOI: 10.1542/hpeds.2019-0173] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. METHODS We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N = 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of ≥1 from baseline, and severe disability was defined as an FSS change of ≥3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI). RESULTS Thirty (9%) patients died. New disability (n = 103; 35%) and severe disability (n = 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in ≥3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability. CONCLUSIONS PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program and .,Divisions of Pediatric Critical Care
| | | | | | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Neurology
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Psychology, and
| | | | - Cindy T McEvoy
- Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative. Pediatr Qual Saf 2020; 5:e256. [PMID: 32190800 PMCID: PMC7056284 DOI: 10.1097/pq9.0000000000000256] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients. Methods We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing. Results All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05). Conclusions This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.
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Outcomes and Patterns of Healthcare Utilization After Hospitalization for Pediatric Critical Illness Due to Respiratory Failure. Pediatr Crit Care Med 2019; 20:120-127. [PMID: 30418338 DOI: 10.1097/pcc.0000000000001797] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. DESIGN Retrospective cohort study. SETTING Quaternary care PICU. PATIENTS Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014. MEASUREMENTS AND MAIN RESULTS Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6-10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0-11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4-15) and 14 days (interquartile range, 8-23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28-1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27-1.71; p < 0.0001) within 2 years. CONCLUSIONS After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.
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Abstract
OBJECTIVE To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. DESIGN A 70-month retrospective before-after study. SETTING Medical and surgical PICU with 20 beds at a tertiary children's hospital. PATIENTS Seventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery. INTERVENTION We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. MEASUREMENTS AND MAIN RESULTS There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0-10.6 min] vs 17.4 min [13.2-26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16-66] vs 23 [19-31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37-99] vs 40 [31-54] postoperative days; p = 0.012). CONCLUSIONS Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.
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Williams CN, Piantino J, McEvoy C, Fino N, Eriksson CO. The Burden of Pediatric Neurocritical Care in the United States. Pediatr Neurol 2018; 89:31-38. [PMID: 30327237 PMCID: PMC6349248 DOI: 10.1016/j.pediatrneurol.2018.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disorders requiring pediatric neurocritical care (PNCC) affect thousands of children annually. We aimed to quantify the burden of PNCC through generation of national estimates of disease incidence, utilization of critical care interventions (CCI), and hospital outcomes. METHODS We performed a retrospective cohort analysis of the Kids Inpatient Database over three years to evaluate pediatric traumatic brain injury, neuro-infection or inflammatory diseases, status epilepticus, stroke, hypoxic ischemic injury after cardiac arrest, and spinal cord injury. We evaluated use of CCI, death, length of stay, hospital charges, and poor functional outcome defined as receipt of tracheostomy or gastrostomy or discharge to a medical care facility. RESULTS At least one CCI was recorded in 67,058 (23%) children with a primary neurological diagnosis, and considered a PNCC admission. Over half of PNCC admissions had at least one chronic condition, and 23% were treated in children's hospitals. Mechanical ventilation was the most common CCI, but utilization of CCIs varied significantly by diagnosis. Among PNCC admissions, 8110 (12%) children died during hospitalization and 14,067 (21%) children had poor functional outcomes. PNCC admissions cumulatively accounted for over 1.5 million hospital days and over $4 billion in hospital costs in the study years. Most PNCC admissions, across all diagnoses, had prolonged hospitalizations (more than one week) with an average cost of $39.9 thousand per admission. CONCLUSIONS This large, nationally representative study shows PNCC diseases are a significant public health burden with substantial risk to children's health. More research is needed to improve outcomes in these vulnerable children.
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Affiliation(s)
- Cydni N. Williams
- Oregon Health and Science University, Department of Pediatrics, Division of Pediatric Critical Care
| | - Juan Piantino
- Division of Pediatric Neurology, Oregon Health and Science University
| | - Cynthia McEvoy
- Division of Neonatology, Oregon Health and Science University
| | - Nora Fino
- Biostatistics and Design Program, Oregon Health and Science University
| | - Carl O. Eriksson
- Oregon Health and Science University, Department of Pediatrics, Division of Pediatric Critical Care
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Bastos VCDS, Carneiro AAL, Barbosa MDSR, Andrade LBD. Brazilian version of the Pediatric Functional Status Scale: translation and cross-cultural adaptation. Rev Bras Ter Intensiva 2018; 30:301-307. [PMID: 30183976 PMCID: PMC6180463 DOI: 10.5935/0103-507x.20180043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/11/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To translate and cross-culturally adapt the Functional Status Scale for
hospitalized children into Brazilian Portuguese. Methods A methodological study of the translation and cross-cultural adaptation of
the Functional Status Scale was conducted, according to the stages of
translation, synthesis of translations, back-translation, synthesis of
back-translations, expert committee analysis and pre-test with a sample of
the target population. During the evaluation by the committee of experts,
semantic, content and item analyses were performed. Results The semantic, idiomatic, cultural and conceptual equivalences between the
translated version and the original version were obtained, resulting in the
Brazilian version of the Functional Status Scale. After the analysis by the
expert committee, there were no problems regarding the cultural or
conceptual equivalences because the items were pertinent to the Brazilian
culture and few terms were modified. In the pre-test stage, the scale was
applied by two evaluators to a sample of 25 children. Clarity and ease in
answering the scale items were observed. Good inter-observer reliability was
obtained, with an intraclass correlation coefficient of 0.85 (0.59 -
0.95). Conclusions The Functional Status Scale for pediatric use was translated and culturally
adapted into Portuguese spoken in Brazil. The translated items were
pertinent to the Brazilian culture and evaluated the dimensions proposed by
the original instrument. Validation studies of this instrument are suggested
to make it feasible for use in different regions of Brazil.
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Affiliation(s)
| | | | | | - Lívia Barboza de Andrade
- Instituto de Medicina Integral Prof. Fernando Figueira - Recife (PE), Brasil.,Hospital Esperança Recife, Rede D'Or São Luiz - Recife (PE), Brasil
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Spiegel E, Jondhale S, Brajkovic I, Nesbit KC, Allen IE, Bhutani V, Kumar P, Partridge JC. Valuation of Quality of Life in Pediatric Disability in a Developing Country. J Child Neurol 2018; 33:601-609. [PMID: 29808780 DOI: 10.1177/0883073818773941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article assessed how Indian providers and mothers value quality of life in pediatric disabilities, hypothesizing lower values with increasing disability, lower values among providers than mothers, and lower values among mothers with versus mothers without a disabled child. We asked 175 participants: "If born tomorrow, how many years of a disabled life ( y) would you trade to avoid life-long disability" for 4 hypothetical disabilities, calculating "utility" scores as: (life span - y) / life span, where death = 0 and full life without disability = 1. Providers' utilities were 0.67 (mild), 0.18 (moderate), -0.70 (severe), and -0.60 (profound); 0.67, 0, -0.77, and -0.88 for mothers without and 0.38, -0.49, -0.86, and -0.87 for mothers with a disabled child. Mothers without reported lower utilities than providers (severe and profound disability [ P ≤ .03]), and higher utilities than mothers (for mild and moderate disability [ P < .001]). Major disability is valued as a fate worse than death in India.
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Affiliation(s)
- Elizabeth Spiegel
- 1 Department of Pediatrics, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA
| | - Sunil Jondhale
- 2 Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ivana Brajkovic
- 1 Department of Pediatrics, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA
| | - Kathryn C Nesbit
- 3 Department of Physical Therapy, University California San Francisco/San Francisco State University, San Francisco, CA, USA
| | - Isabel E Allen
- 4 Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA, USA
| | - Vinod Bhutani
- 5 Department of Neonatology, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Praveen Kumar
- 2 Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - John Colin Partridge
- 1 Department of Pediatrics, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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Watson RS, Asaro LA, Hertzog JH, Sorce LR, Kachmar AG, Dervan LA, Angus DC, Wypij D, Curley MAQ. Long-Term Outcomes after Protocolized Sedation versus Usual Care in Ventilated Pediatric Patients. Am J Respir Crit Care Med 2018; 197:1457-1467. [PMID: 29313710 PMCID: PMC6005554 DOI: 10.1164/rccm.201708-1768oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2018] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects postdischarge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown. OBJECTIVES To compare postdischarge outcomes in children with acute respiratory failure cluster-randomized to a sedation protocol or usual care. METHODS A stratified random sample of 1,360 patients from 31 centers in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial was assessed by mail, electronically, and/or telephone 6 months after ICU discharge. In treatment group comparisons, we controlled for age, baseline functional status, and severity of illness. MEASUREMENTS AND MAIN RESULTS We used the Pediatric Overall Performance Category and the Pediatric Cerebral Performance Category to characterize functional status, the Infant and Toddler Quality of Life Questionnaire (97-item full-length version) (<2 yr old) or Pediatric Quality of Life Inventory (≥2 yr old), and the Child Post-traumatic Stress Disorder Symptom Scale (≥8 yr old and developmentally able). Functional status worsened from baseline to follow-up in 20%. Decline in functional status did not differ by treatment arm and was more common among those with baseline impairment than those with baseline normal function (27 vs. 18%; P < 0.001). There were no significant differences in health-related quality of life total scores by treatment arm. Scores indicating risk of post-traumatic stress disorder occurred in 30%, with no difference between treatment arms. CONCLUSIONS A sedation strategy that allows patients to be more awake and exposes them to fewer sedative and analgesic medications produces no long-term harm. However, postdischarge morbidity after acute respiratory failure is common. Clinical trial registered with www.clinicaltrials.gov (NCT00814099).
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Affiliation(s)
- R. Scott Watson
- Department of Pediatrics, University of Washington, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | | | - James H. Hertzog
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Lauren R. Sorce
- Division of Pediatric Critical Care, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | | | - Leslie A. Dervan
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Derek C. Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center and
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Wypij
- Department of Cardiology and
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martha A. Q. Curley
- Critical Care and Cardiovascular Program, Boston Children’s Hospital, Boston, Massachusetts
- School of Nursing and
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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PICS-p: It Is About Time (and Family)! But How Did Adult Medicine Beat Pediatrics to a Holistic View of the Patient? Pediatr Crit Care Med 2018; 19:375-377. [PMID: 29620709 DOI: 10.1097/pcc.0000000000001498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Williams CN, Eriksson C, Piantino J, Hall T, Moyer D, Kirby A, McEvoy C. Long-term Sequelae of Pediatric Neurocritical Care: The Parent Perspective. J Pediatr Intensive Care 2018; 7:173-181. [PMID: 31073491 DOI: 10.1055/s-0038-1637005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/07/2018] [Indexed: 02/06/2023] Open
Abstract
Critical neurologic disease and injury affect thousands of children annually with survivors suffering high rates of chronic morbidities related directly to the illness and to critical care hospitalization. Postintensive care syndrome (PICS) in patients and families encompasses a variety of morbidities including physical, cognitive, emotional, and psychological impairments following critical care. We conducted a focus group study with parents of children surviving pediatric neurocritical care (PNCC) for traumatic brain injury, stroke, meningitis, or encephalitis to determine outcomes important to patients and families, identify barriers to care, and identify potential interventions to improve outcomes. Sixteen parents participated in four groups across Oregon. Three global themes were identified: (1) PNCC is an intense emotional experience for the whole family; (2) PNCC survivorship is a chronic illness; and (3) PNCC has a significant psychological and social impact. Survivors and their families suffer physical, emotional, psychological, cognitive, and social impairments for many years after discharge. Parents in this study highlighted the emotional and psychological distress in survivors and families after PNCC, in contrast to most PNCC research focusing on physical outcomes. Several barriers to care were identified with potential implications on survivor outcomes, including limited pediatric resources in rural settings, perceived lack of awareness of PICS among medical providers, and the substantial financial burden on families. Parents desire improved education surrounding PICS morbidities for families and medical providers, improved communication with primary care providers after discharge, access to educational materials for patients and families, direction to mental health providers, and family support groups to assist them in dealing with morbidities and accessing appropriate resources. Clinicians and researchers should consider the parent perspectives reported here when caring for and evaluating outcomes for children requiring PNCC.
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Affiliation(s)
- Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Carl Eriksson
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Juan Piantino
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Trevor Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Danielle Moyer
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Aileen Kirby
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Cindy McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
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Choong K, Canci F, Clark H, Hopkins RO, Kudchadkar SR, Lati J, Morrow B, Neu C, Wieczorek B, Zebuhr C. Practice Recommendations for Early Mobilization in Critically Ill Children. J Pediatr Intensive Care 2018; 7:14-26. [PMID: 31073462 PMCID: PMC6260323 DOI: 10.1055/s-0037-1601424] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/23/2017] [Indexed: 12/20/2022] Open
Abstract
Prolonged immobility is associated with significant short- and long-term morbidities in critically ill adults and children. The majority of critically ill children remain immobilized while in the pediatric intensive care unit (PICU) due to limited awareness of associated morbidities, lack of comfort and knowledge on how to mobilize critically ill children, and the lack of pediatric-specific practice guidelines. The objective of this article was to develop consensus practice recommendations for safe, early mobilization (EM) in critically ill children. A group of 10 multidisciplinary experts with clinical and methodological expertise in physical rehabilitation, EM, and pediatric critical care collaborated to develop these recommendations. First, a systematic review was conducted to evaluate existing evidence on EM in children. Using an iterative process, the working document was circulated electronically to panel members until the group reached consensus. The group agreed that the overall goals of mobilization are to reduce PICU morbidities and optimize recovery. EM should therefore not be instituted in isolation but as part of a rehabilitation care bundle. Mobilization should not be delayed, but its appropriateness and safety should be assessed early. Increasing levels of physical activity should be individualized for each patient with the goal of achieving the highest level of functional mobility that is developmentally appropriate, for increasing durations, daily. We developed a system-based set of clinical safety criteria and a checklist to ensure the safety of mobilization in critically ill children. Although there is a paucity of pediatric evidence on the efficacy of EM, there is ample evidence that prolonged bed rest is harmful and should be avoided. These EM practice recommendations were developed to educate clinicians, encourage safe practices, reduce PICU-acquired morbidities, until future pediatric research provides evidence on effective rehabilitation interventions and how best to implement these in critically ill children.
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Affiliation(s)
- Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Filomena Canci
- Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Heather Clark
- Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ramona O. Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, United States
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jamil Lati
- Division of Rehabilitation, Department of Physical Therapy, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Brenda Morrow
- Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Charmaine Neu
- Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Beth Wieczorek
- Department of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Carleen Zebuhr
- Section of Critical Care, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, United States
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Yagiela LM, Harper FW, Meert KL. Reframing pediatric cardiac intensive care outcomes: The importance of the family and the role of pediatric medical traumatic stress. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forsyth R, Young D, Kelly G, Davis K, Dunford C, Golightly A, Marshall L, Wales L. Paediatric Rehabilitation Ingredients Measure: a new tool for identifying paediatric neurorehabilitation content. Dev Med Child Neurol 2018; 60:299-305. [PMID: 29266225 DOI: 10.1111/dmcn.13648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 02/01/2023]
Abstract
AIM To develop an instrument (Paediatric Rehabilitation Ingredients Measure [PRISM]) for quantitative estimation of contents of interdisciplinary neurorehabilitation for use in studies of relationships between rehabilitation treatment delivered and severity-adjusted outcomes after acquired brain injury (ABI). METHOD The measure was developed using an ingredients-mediators-outcomes model consistent with the International Classification of Functioning, Disability and Health, a literature review, and other current initiatives in the development of rehabilitation treatment taxonomies, with item codevelopment in workshops with rehabilitation professionals. Interrater reliability was assessed in inpatient and residential paediatric rehabilitation settings. RESULTS Although sometimes an initially unfamiliar perspective on rehabilitation practice, PRISM's acceptability amongst professionals was excellent. Internal consistency of scores was sometimes an issue for users unfamiliar with the tool; however, this improved with practice and interrater reliability (assessed by Kendall's W) was good. The tool was felt to have particular value in facilitating interdisciplinary communication and working. Modifications to the design of the tool have improved internal consistency. INTERPRETATION PRISM supports identification of the 'active ingredients' of an interdisciplinary rehabilitation package and facilitates interdisciplinary communication. It also has potential as a research tool examining relationships between rehabilitation delivered and severity-adjusted outcomes observed after paediatric ABI. WHAT THIS PAPER ADDS Identifying contribution of rehabilitation to outcomes after acquired brain injury requires quantification of rehabilitation 'dose' and 'content'. Previous approaches to 'parsing' of rehabilitation dose and content may have overemphasized one-to-one sessions with therapists. We present a novel, holistic tool for identification of ingredients of an interdisciplinary rehabilitation package. It supports interdisciplinary communication and has potential as a research tool.
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Affiliation(s)
- Rob Forsyth
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Young
- Paediatric Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gemma Kelly
- The Children's Trust, Harrison Research Centre, Tadworth, UK
| | - Kathy Davis
- The Children's Trust, Harrison Research Centre, Tadworth, UK
| | - Carolyn Dunford
- The Children's Trust, Harrison Research Centre, Tadworth, UK
| | - Andrew Golightly
- Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - Lindsay Marshall
- School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Lorna Wales
- The Children's Trust, Harrison Research Centre, Tadworth, UK
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Beyond Survival: Pediatric Critical Care Interventional Trial Outcome Measure Preferences of Families and Healthcare Professionals. Pediatr Crit Care Med 2018; 19:e105-e111. [PMID: 29394234 DOI: 10.1097/pcc.0000000000001409] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To identify, in addition to survival, preferred outcome measures of PICU family care providers and PICU healthcare professionals for interventional trials enrolling critically ill children, and to describe general attitudes of family care providers and healthcare professionals regarding research in the PICU. DESIGN Cross-sectional survey examining subject experience with clinical research and personal preferences for outcome measures for a hypothetical interventional clinical trial. SETTING PICUs within four academic children's hospitals in the United States and Canada. SUBJECTS Two cohorts including family members of critically ill children in PICUs (family care providers) and multidisciplinary staff working in the PICUs (healthcare professionals). INTERVENTIONS Administration of a short, deidentified survey. MEASUREMENTS Demographic data were collated for the two subject groups. Participants were queried regarding their attitudes related to research conducted in the PICU. In addition to survival, each group was asked to identify their three most important outcomes for an investigation examining whether or not an intervention helps seriously ill children recover. MAIN RESULTS Demographics for family care providers (n = 40) and healthcare professionals (n = 53) were similarly distributed. Female respondents (79.8%) predominated. Participants (98.9%) ascertained the importance of conducting research in the PICU, but significant challenges associated with this goal in the high stress PICU environment. Both quality of life and functioning after leaving the hospital were chosen as the most preferred outcome measure, with 77.5% of family care providers and 84.9% of healthcare professionals indicating this choice. Duration of organ dysfunction was identified by 70.0% of family care providers and 40.7% of healthcare professionals as the second most preferred outcome measure. CONCLUSIONS In addition to survival, long-term quality of life/functional status and duration of organ dysfunction represent important interventional trial outcome measures for both families of critically ill children, as well as the multidisciplinary team who provides critical care.
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