Early Rehabilitation in Critically ill Children: A Two Center Implementation Study

Area of Science:

• Pediatric Critical Care Medicine
• Implementation Science
• Rehabilitation Therapy

Background:

• Pediatric intensive care units (PICUs) often involve prolonged sedation and immobility.
• Early rehabilitation interventions are crucial for improving outcomes in critically ill children.
• Implementing standardized care bundles presents implementation challenges.

Purpose of the Study:

• To implement and evaluate an early rehabilitation bundle in two Canadian PICUs.
• To assess the impact of the bundle on processes of care, safety, and clinical outcomes.
• To identify facilitators and barriers to bundle implementation.

Main Methods:

• An implementation study was conducted in two Canadian PICUs.
• The rehabilitation bundle included analgesia-first sedation, delirium monitoring/prevention, and early mobilization.
• Data on implementation, compliance, safety, and clinical outcomes were collected over 26 months.

Main Results:

• Bundle compliance was achieved within six months; goal setting for mobilization improved.
• Sedative (benzodiazepine, opioid, dexmedetomidine) use decreased significantly at one site.
• No adverse effects on patient comfort, safety, or nursing workload were observed.
• No significant impact on delirium, ventilator-free days, length of stay, or mortality.

Conclusions:

• An early rehabilitation bundle can enhance PICU care processes and reduce sedative exposure safely.
• The bundle did not significantly improve short-term clinical outcomes in this implementation study.
• Further research is needed to confirm the efficacy of PICU rehabilitation bundles.