Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.
PLoS One. 2022 Mar 31;17(3):e0266360. doi: 10.1371/journal.pone.0266360. eCollection 2022.
Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting its use.
We conducted a retrospective cohort analysis of rehabilitation between 2013 and 2019 using the Korean National Health Insurance database. All patients aged 28 days to 18 years who had been admitted to 245 ICUs for more than 2 days were included. Neonatal ICUs were excluded.
Of 13,276 patients, 2,447 (18%) received PT/OT-provided rehabilitation during their hospitalization; prevalence was lowest for patients younger than 3 years (11%). Neurologic patients were most likely to receive rehabilitation (adjusted odds ratio [aOR], 6.47; 95% confidence interval [CI], 5.11-8.20). Longer ICU stay (versus ≤ 1 week) was associated with rehabilitation (aOR for 1-2 weeks, 3.50 [95% CI, 3.04-4.03]; 2-3 weeks, 6.60 [95% CI, 5.45-8.00]; >3 weeks, 13.69 [95% CI, 11.46-16.35]). Mechanical ventilation >2 days (aOR, 0.78; 95% CI, 0.67-0.91) and hemodialysis (aOR, 0.50; 95% CI, 0.41-0.52) were negatively affecting factors.
Prevalence of rehabilitation for critically ill children was low and concentrated on patients with a prolonged ICU stay. The finding that mechanical ventilation, a risk factor for ICU-acquired weakness, was an obstacle to rehabilitation highlights the need for studies on early preventive rehabilitation based on individual patient needs.
重症监护病房（ICU）幸存者身体虚弱，难以恢复正常生活。随着人们越来越认识到儿科 ICU 患者康复的重要性，我们评估了身体和职业治疗（PT/OT）提供的康复的流行情况以及影响其使用的因素。
我们使用韩国国家健康保险数据库，对 2013 年至 2019 年期间的康复情况进行了回顾性队列分析。所有年龄在 28 天至 18 岁之间、在 245 个 ICU 住院超过 2 天的患者均纳入研究。新生儿 ICU 患者被排除在外。
在 13276 名患者中，有 2447 名（18%）在住院期间接受了 PT/OT 提供的康复治疗；年龄小于 3 岁的患者接受康复治疗的比例最低（11%）。神经科患者最有可能接受康复治疗（调整后的优势比 [aOR]，6.47；95%置信区间 [CI]，5.11-8.20）。ICU 住院时间延长（与≤1 周相比）与康复相关（1-2 周 aOR，3.50；95%CI，3.04-4.03；2-3 周 aOR，6.60；95%CI，5.45-8.00；>3 周 aOR，13.69；95%CI，11.46-16.35）。机械通气>2 天（aOR，0.78；95%CI，0.67-0.91）和血液透析（aOR，0.50；95%CI，0.41-0.52）是负性影响因素。
危重症儿童康复治疗的比例较低，且主要集中在 ICU 住院时间延长的患者中。机械通气是 ICU 获得性肌无力的危险因素，但却是康复的障碍，这一发现突出表明需要根据患者个体需求，开展关于早期预防性康复的研究。
