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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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Choong K, Zorko DJ, Awojoodu R, Ducharme-Crevier L, Fontela PS, Lee LA, Guerguerian AM, Garcia Guerra G, Krmpotic K, McKelvie B, Menon K, Murthy S, Sehgal A, Weiss MJ, Kudchadkar SR. Prevalence of Acute Rehabilitation for Kids in the PICU: A Canadian Multicenter Point Prevalence Study. Pediatr Crit Care Med 2021; 22:181-193. [PMID: 33116069 DOI: 10.1097/pcc.0000000000002601] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate mobilization practices, barriers, and mobility-related adverse events in Canadian PICUs. DESIGN National 2-day point prevalence study. SETTING Thirteen PICUs across Canada. PATIENTS Children with a minimum 72-hour PICU length of stay on the allocated study day. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Outcomes of interest were the prevalence and nature of mobilization activities, rehabilitation resources, adverse events, and factors associated with out-of-bed mobility and therapist-provided mobility. Two PICUs (15%) had early mobilization practice guidelines, and one PICU (8%) reported a formal process for engaging families in the mobilization of patients. The prevalence of mobilization was 110 of 137 patient-days (80%). The commonest activity was out-of-bed mobility (87/137; 64% patient-days); there was no active mobilization on 46 patient-days (34%). Therapists provided mobility on 33% of patient-days. Mobility was most commonly facilitated by nurses (74% events) and family (49% events). Family participation was strongly associated with out-of-bed mobility (odds ratio 6.4; p = 0.001). Intubated, mechanically ventilated patients were mobilized out-of-bed on 18 of 50 patient-days (36%). However, the presence of an endotracheal tube, vasoactive infusions, and age greater than or equal to 3 years were independently associated with not being mobilized out-of-bed. Barriers were reported on 58 of 137 patient-days (42%), and adverse events occurred in 22 of 387 mobility events (6%). CONCLUSIONS Mobilization is common and safe, and the majority of children in Canadian PICUs are being mobilized out-of-bed, even when mechanically ventilated. Family engagement in PICU-based rehabilitation is increasing. This study provides encouraging evidence that common barriers can be overcome in order to safely mobilize children in PICUs.
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Affiliation(s)
- Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - David J Zorko
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ronke Awojoodu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Laurie A Lee
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Anne-Marie Guerguerian
- Departments of Critical Care Medicine and Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Kristina Krmpotic
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Brianna McKelvie
- Department of Pediatrics, Western University, London, ON, Canada
| | - Kusum Menon
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anupam Sehgal
- Department of Pediatrics, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
| | - Matthew J Weiss
- Department of Pediatrics, Université Laval Faculté de Médecine, Québec, QC, Canada
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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