Department of Pediatric Intensive Care, Saitama Children's Medical Center, Saitama, Japan.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Intensive Care Med. 2020 Apr;35(4):405-410. doi: 10.1177/0885066618754507. Epub 2018 Jan 22.
Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program.
We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression.
Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score ( < .001), baseline motor impairment ( < .01), developmental delay ( = .04), mechanical ventilation ( = .1), and number of devices ( = .01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34).
Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.
成人重症监护病房（ICU）中的早期患者活动与改善功能结果和缩短 ICU 住院时间有关。尽管新出现的证据表明儿科 ICU（PICU）中的早期活动是安全且可行的，但由于认为患者病情严重不容许进行活动，物理治疗师（PT）的咨询可能会延迟。影响及时让 PT 参与促进危重症儿童急性康复的因素尚未确定。本研究的目的是在大规模实施多组分早期活动计划之前，确定三级护理 PICU 中早期 PT 咨询的患者水平因素。
我们对 PICU Up！质量改进计划的数据进行了回顾性分析。主要结局是早期康复，定义为 PICU 入院后 3 天内进行 PT 咨询。根据结局将患者（n=100）分为 2 组，并用逻辑回归分析早期康复的预测因素。
在 100 名儿童中，54%接受了早期康复。在单变量分析中，较高的儿科死亡风险评分（PRISM）（<.001）、基线运动障碍（<.01）、发育迟缓（=.04）、机械通气（=.1）和设备数量（=.01）与早期康复有关。在逻辑回归模型中，早期康复的预测因素包括基线运动障碍（调整后的优势比=5.36，95%置信区间[CI] = 1.3-22.0）和较高的 PRISM 评分（调整后的优势比=1.17，95% CI = 1.02-1.34）。
在实施单位范围的早期活动计划之前，具有正常基线功能或较低疾病严重程度的危重症儿童不太可能开始接受 PT 的早期康复。基线运动障碍和较高的 PRISM 评分与早期康复独立相关。这些发现强调需要简化 PT 咨询的标准，以满足所有危重症患者的康复需求。
