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Post-Intensive Care Sequelae in Pediatrics-Results of an Early Rehabilitation Implementation Study
Karen Choong1,2, Douglas D Fraser3, Saoirse Cameron4
1Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Insights
Early rehabilitation bundles in pediatric intensive care units (PICUs) did not significantly improve post-discharge functioning or quality of life. Persistent low functioning is common in PICU survivors, but combined functional decline and low quality of life are rare.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Medicine
- Health Services Research
Background:
- Pediatric intensive care unit (PICU) survivors often experience long-term functional deficits and reduced health-related quality of life (HRQL).
- Early rehabilitation interventions aim to mitigate these adverse outcomes.
- The effectiveness of a comprehensive early rehabilitation bundle in improving patient-centered outcomes requires further investigation.
Purpose of the Study:
- To compare post-PICU discharge functioning, HRQL, and parental stress before and after implementing an early rehabilitation bundle.
- To assess the impact of a multi-component rehabilitation strategy on pediatric patient recovery.
Main Methods:
- A prospective cohort substudy was conducted within an early rehabilitation implementation program at two Canadian PICUs.
- The rehabilitation bundle included analgesia-first sedation, delirium monitoring/prevention, and early mobilization.
- Patient-reported outcomes (functioning, HRQL, caregiver stress) were assessed at baseline, PICU discharge, and 1 and 3 months post-discharge.
Main Results:
- No significant differences in persistent functional decline, low HRQL, or caregiver stress were observed post-bundle implementation compared to pre-implementation.
- At PICU discharge, 63.8% of patients experienced functional decline and 40% had low HRQL.
- Persistent functional decline and/or low HRQL were noted in 50% at 1 month and 36.8% at 3 months; however, experiencing both was uncommon (2.6-2.8%).
Conclusions:
- This substudy was underpowered to definitively determine the efficacy of the rehabilitation bundle on patient-centered outcomes.
- Persistent low functioning is a common issue among pediatric PICU survivors.
- While functional decline is frequent, the combination of functional decline and low HRQL is less common in this population.
Objectives:
To compare post-PICU discharge functioning, health-related quality of life (HRQL), and parental stress before and after the implementation of an early rehabilitation bundle.
Design And Setting:
Prospective cohort substudy within an early rehabilitation implementation program, conducted at the PICUs at McMaster Children's Hospital and London Health Sciences, London, Ontario, Canada.
Interventions:
A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. Patients with an anticipated 48-hour PICU length of stay were approached for consent to participate.
Patients:
Critically ill children with an anticipated 48-hour PICU length of stay were approached for consent to participate.
Measurements And Main Results:
Patient-/proxy-reported outcome measures were assessed at baseline, PICU discharge, and 1 and 3 months post-PICU discharge using: 1) Pediatric Evaluation of Disability Inventory Computer Adaptive Test to assess physical, social, cognitive, and responsibility/caregiver domains of functioning; 2) KIDSCREEN to assess HRQL; and 3) the Pediatric Inventory for Parents to assess caregiver stress. A total of 117 participants were enrolled. Patient demographic characteristics were similar in the pre- and post-intervention groups. Following bundle implementation, 30 of 47 respondents (63.8%) experienced functional decline and 18 of 45 (40%) experienced low HRQL at PICU discharge. Eighteen of 36 (50%) at 1 month and 14 of 38 (36.8%) at 3 months experienced either persistent functional decline and/or low HRQL; 2.8% and 2.6% at 1- and 3-month follow-up, respectively, experienced both persistent functional decline and low HRQL. There were no significant differences in the rates of persistent functional decline, low HRQL, or caregiver stress scores post-bundle compared with pre-rehabilitation bundle implementation.
Conclusions:
We were unable to adequately determine the efficacy of a rehabilitation bundle on patient-centered outcomes as this substudy was not powered for these outcomes. Our results did reveal that persistent low functioning is common in PICU survivors, more common than low HRQL, while experiencing both functional decline and low HRQL was uncommon.
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