Acute Rehabilitation Practices in Critically Ill Children: A Multicenter Study
Acute Rehabilitation Practices in Critically Ill Children: A Multicenter Study
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DOI：
10.1097/pcc.0000000000000160
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发表时间：
2014-07-01
影响因子：
4.1
通讯作者：
Ward, Roxanne E.
中科院分区：
文献类型：
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作者：
Choong, Karen;Foster, Gary;Ward, Roxanne E.
目的：评估加拿大儿科重症监护病房的急性康复实践。设计：回顾性队列研究。环境：六个加拿大三级儿科重症监护病房。患者/受试者：2011年冬季和夏季住院时间大于24小时的600名17岁以下儿童入住儿科重症监护病房。干预措施:没有。测量和主要结果：主要研究结果是儿科重症监护病房康复实践的性质和时间。康复按照活动干预和非活动干预进行分类。分别通过回归分析和时间依赖生存分析评估动员和动员时间的预测因子。儿科重症监护病房最常见的康复形式是物理治疗（45.5%），其次是职业治疗（4.5%）和言语和语言治疗（1.5%）。干预措施主要是不活动（69.7%），最常见的形式是胸部物理治疗（42.7%）。活动的中位时间为2天（四分位数范围，1-6），而非活动干预的中位时间为1天（四分位数范围，1-3）。只有57例患者（9.5%）接受了早期动员。回归分析显示，年龄增加、冬季入院、神经肌肉阻断和镇静输注与接受活动能力治疗的可能性增加有关。年龄增加是早期活动的预测因子，而神经肌肉阻滞与延迟活动相关。在不活动和活动干预之间没有发现显著的不良事件差异。结论：只有一半的儿童在重症监护病房接受康复治疗，即使出现康复治疗，治疗也主要集中在呼吸功能方面。运动似乎是为肌肉放松和镇静的高危儿童保留的；然而，它在这些患者中的实施是延迟的。未来的儿科特异性研究对于确定有风险的患者，了解治疗重点和康复策略以改善危重患儿的功能恢复至关重要。
Objective: To evaluate acute rehabilitation practices in pediatric critical care units across Canada.Design: Retrospective cohort study.Setting: Six Canadian, tertiary care pediatric critical care units.Patients/Subjects: Six hundred children aged under 17 years admitted to pediatric critical care unit during a winter and summer month of 2011 with a greater than 24-hour length of stay.Interventions: None.Measurements and Main Results: The primary outcome of interest was the nature and timing of pediatric critical care unit rehabilitation practices. Rehabilitation was classified according to mobility and nonmobility interventions. Predictors of mobilization and the time to mobilization were evaluated through regression and time-dependent survival analyses, respectively. The most common form of rehabilitation provided in pediatric critical care unit was physical therapy (45.5% patients) followed by occupational therapy (4.5%) and speech and language therapy (1.5%). Interventions were primarily nonmobility in nature (69.7% of sessions), most frequently in the form of chest physiotherapy (42.7% of sessions). The median time to mobilization was 2 days (interquartile range, 1-6) as compared with 1 day for nonmobility interventions (interquartile range, 1-3). Only 57 patients (9.5%) received early mobilization. Regression analyses revealed that increasing age, admission during winter, neuromuscular blockade, and sedative infusions were associated with an increased likelihood of receiving mobility therapy. Increasing age was a predictor of early mobilization, while neuromuscular blockade was associated with delayed mobilization. No significant differences in adverse events were found between nonmobility and mobility interventions.Conclusions: Only half of the children receive rehabilitation while in the pediatric critical care unit, and when it occurs, therapy is primarily focused on respiratory function. Mobilization appears to be reserved for at-risk children who were muscle relaxed and sedated; however, its implementation in these patients is delayed. Future pediatric-specific research is essential to identify patients at risk and to understand treatment priorities and rehabilitation strategies to improve functional recovery in critically ill children.