Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States.


OBJECTIVES:With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers. DESIGN:National 2-day point prevalence study. SETTING:Eighty-two PICUs in 65 hospitals across the United States. PATIENTS:All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was prevalence of physical therapy- or occupational therapy-provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility-associated safety events, and barriers to mobility. The point prevalence of physical therapy- or occupational therapy-provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13-17 vs < 3 yr, 2.1; 95% CI, 1.5-3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61-0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1-0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1-0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1-6.6). CONCLUSIONS:Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.


Crit Care Med


Critical care medicine


Kudchadkar SR,Nelliot A,Awojoodu R,Vaidya D,Traube C,Walker T,Needham DM,Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.




Has Abstract


2020-05-01 00:00:00












  • Are Peripherally Inserted Central Catheters Suitable for Cardiac Output Assessment With Transpulmonary Thermodilution?

    abstract:OBJECTIVES:Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: D'Arrigo S,Sandroni C,Cacciola S,Dell'Anna AM,Pittiruti M,Annetta MG,Colosimo C,Antonelli M

    更新日期:2019-10-01 00:00:00

  • Hyperkalemia during cardiac arrest and resuscitation in the canine model.

    abstract::Although recent clinical reports have noted hypokalemia after resuscitation from cardiac arrest, extensive animal work indicates that potassium is released from cells during ischemia. This study was undertaken to define the changes that occur in serum potassium ion during cardiac arrest and resuscitation in a canine m...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Martin GB,Carden DL,Nowak RM,Foreback C,Tomlanovich MC

    更新日期:1986-04-01 00:00:00

  • Selenium, systemic immune response syndrome, sepsis, and outcome in critically ill patients.

    abstract:OBJECTIVES:To confirm early, marked decrease in plasma selenium concentrations in patients admitted to a surgical and medical intensive care unit (ICU), and to study this decrease according to the presence or absence of systemic inflammatory response syndrome (SIRS), sepsis, or direct ischemia-reperfusion. DESIGN:Pros...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Forceville X,Vitoux D,Gauzit R,Combes A,Lahilaire P,Chappuis P

    更新日期:1998-09-01 00:00:00

  • Efficacy of silver-coating central venous catheters in reducing bacterial colonization.

    abstract:OBJECTIVE:To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. DESIGN:Prospective, randomized clinical trial. SETTING:Intensive care unit in a university hospital. PATIE...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Bach A,Eberhardt H,Frick A,Schmidt H,Böttiger BW,Martin E

    更新日期:1999-03-01 00:00:00

  • The Randomized Educational Acute Respiratory Distress Syndrome Diagnosis Study: A Trial to Improve the Radiographic Diagnosis of Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVES:Radiographic criteria for acute respiratory distress syndrome have been criticized for poor reliability. Our objective was to test an educational intervention to improve the radiographic identification of acute respiratory distress syndrome by participants in the Large Observational Study to Understand the G...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Goddard SL,Rubenfeld GD,Manoharan V,Dev SP,Laffey J,Bellani G,Pham T,Fan E

    更新日期:2018-05-01 00:00:00

  • Can Concurrent Abnormalities in Free Light Chains and Immunoglobulin Concentrations Identify a Target Population for Immunoglobulin Trials in Sepsis?

    abstract:OBJECTIVES:Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin tria...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Shankar-Hari M,Singer M,Spencer J

    更新日期:2017-11-01 00:00:00

  • Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy.

    abstract:OBJECTIVE:To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy. DESIGN:Case report. SETTING:Medical intensive care unit of a tertiary care academic medical center. PATIENT:A 35-yr-old woman 5 wks postpartum from an uneven...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fussell KM,Awad JA,Ware LB

    更新日期:2005-04-01 00:00:00

  • Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials.

    abstract:OBJECTIVES:Randomized trials have suggested that hypertonic saline solutions may be superior to mannitol for the treatment of elevated intracranial pressure, but their impact on clinical practice has been limited, partly by their small size. We therefore combined their findings in a meta-analysis. DATA SOURCES:We sear...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析


    authors: Kamel H,Navi BB,Nakagawa K,Hemphill JC 3rd,Ko NU

    更新日期:2011-03-01 00:00:00

  • Hepatic Compartment Syndrome Following Percutaneous Cholecystostomy: A Case Report.

    abstract:OBJECTIVE:To describe a case of hepatic subcapsular hematoma causing an acute Budd-Chiari-like syndrome, leading to hepatic compartment syndrome, which combines compression of intrahepatic vessels on CT, acute liver failure, and refractory shock. DESIGN:Case report. SETTING:Surgical ICU of a university teaching hospi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marcaire F,Malavieille F,Pichot-Delahaye V,Floccard B,Rimmelé T

    更新日期:2016-03-01 00:00:00

  • Development and Validation of an Empiric Tool to Predict Favorable Neurologic Outcomes Among PICU Patients.

    abstract:OBJECTIVES:To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness. DESIGN:Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regressio...

    journal_title:Critical care medicine

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    authors: Gupta P,Rettiganti M,Gossett JM,Daufeldt J,Rice TB,Wetzel RC

    更新日期:2018-01-01 00:00:00

  • Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis.

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    更新日期:2017-08-01 00:00:00

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    journal_title:Critical care medicine

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    authors: Schwenzer KJ,Wang L

    更新日期:2006-12-01 00:00:00

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Martinez JA,DesJardin JA,Aronoff M,Supran S,Nasraway SA,Snydman DR

    更新日期:2002-01-01 00:00:00

  • Acute respiratory distress syndrome: frequency, clinical course, and costs of care.

    abstract:OBJECTIVE:To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN:A 3-yr (199...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Valta P,Uusaro A,Nunes S,Ruokonen E,Takala J

    更新日期:1999-11-01 00:00:00

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    authors: Sagalyn E,Band RA,Gaieski DF,Abella BS

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    journal_title:Critical care medicine

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cheng EY,May J

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  • Coronary constriction and consequent cardiodepression in pulmonary embolism are mediated by pulmonary big endothelin and enhanced in early endothelial dysfunction.

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    pub_type: 指南,杂志文章,实务指引



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    pub_type: 杂志文章


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    authors: Zimmerman JE,Shortell SM,Knaus WA,Rousseau DM,Wagner DP,Gillies RR,Draper EA,Devers K

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    authors: Claassen J,Vu A,Kreiter KT,Kowalski RG,Du EY,Ostapkovich N,Fitzsimmons BF,Connolly ES,Mayer SA

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  • Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature.

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    pub_type: 杂志文章


    authors: Khan IR,Saulle M,Oldham MA,Weber MT,Schifitto G,Lee HB

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Chen CT,Toung TJ,Rogers MC

    更新日期:1985-04-01 00:00:00

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Nylén ES,Al Arifi A,Becker KL,Snider RH Jr,Alzeer A

    更新日期:1997-08-01 00:00:00

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    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Zohar D,Livne Y,Tenne-Gazit O,Admi H,Donchin Y

    更新日期:2007-05-01 00:00:00

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    abstract::Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose ep...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Goetting MG,Paradis NA

    更新日期:1989-12-01 00:00:00

  • Opioid receptors control viral replication in the airways.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Salimi V,Hennus MP,Mokhtari-Azad T,Shokri F,Janssen R,Hodemaekers HM,Rygiel TP,Coenjaerts FE,Meyaard L,Bont L

    更新日期:2013-01-01 00:00:00