Acute rehabilitation practices in critically ill children: a multicenter study

Area of Science:

• Pediatric Critical Care Medicine
• Rehabilitation Therapy
• Clinical Practice Evaluation

Background:

• Rehabilitation is crucial for critically ill children to improve functional outcomes.
• Current rehabilitation practices in Canadian pediatric critical care units (PCCUs) are not well-defined.
• Understanding these practices is essential for optimizing patient recovery.

Purpose of the Study:

• To evaluate the nature and timing of acute rehabilitation interventions provided in Canadian PCCUs.
• To identify factors influencing the delivery of mobility and non-mobility interventions.
• To assess the timeliness of mobilization in critically ill children.

Main Methods:

• Retrospective cohort study involving 600 children across six Canadian tertiary PCCUs.
• Data collected on rehabilitation interventions (mobility and non-mobility) and timing.
• Regression and survival analyses used to identify predictors of mobilization and time to mobilization.

Main Results:

• Physical therapy was the most common rehabilitation (45.5%), primarily non-mobility focused (69.7%), such as chest physiotherapy (42.7%).
• Median time to mobilization was 2 days, with only 9.5% receiving early mobilization.
• Older age, winter admission, neuromuscular blockade, and sedative infusions predicted mobility therapy; older age predicted early mobilization, while blockade delayed it.

Conclusions:

• Rehabilitation is underutilized in PCCUs, with a primary focus on respiratory care rather than active mobility.
• Mobilization is often delayed, even in high-risk patients (sedated, muscle-relaxed).
• Pediatric-specific research is needed to refine rehabilitation strategies and improve functional recovery in critically ill children.