In:
Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 20, No. 6 ( 2019-06), p. 540-550
Abstract:
s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. Design: Randomized controlled trial. Setting: Three tertiary care PICUs in the United States. Patients: Fifty-eight children between the ages of 3–17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. Interventions: Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). Measurements and Main Results: Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized ( n = 26) and usual care groups ( n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects ( p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 ( p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 ( p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 ( p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 ( p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 ( p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p 〈 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. Conclusions: A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.
Type of Medium:
Online Resource
ISSN:
1529-7535
DOI:
10.1097/PCC.0000000000001881
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2070997-3
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