Abstract:
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.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
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.doi
10.1097/CCM.0000000000004291subject
Has Abstractpub_date
2020-05-01 00:00:00pages
634-644issue
5eissn
0090-3493issn
1530-0293journal_volume
48pub_type
杂志文章abstract:OBJECTIVES:To describe the effectiveness of a comprehensive, interdisciplinary sepsis treatment protocol with regard to both implementation and outcomes and to compare the mortality rates and therapies of patients with septic shock with similar historical controls. DESIGN:Prospective, interventional cohort study with ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000206104.18647.A8
更新日期:2006-04-01 00:00:00
abstract:OBJECTIVES:Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investi...
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abstract:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency...
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更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:To review published studies of the influence of platelet factor 4 (PF4) and other cationic proteins on the generation of activated protein C (APC) by the thrombomodulin-protein C system. DATA SOURCE:Using the PubMed citation index, literature published from 1973 to 2003 regarding cationic proteins, PF4, and ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000126359.92825.e9
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
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doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
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更新日期:2006-11-01 00:00:00
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更新日期:2020-11-01 00:00:00
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doi:10.1097/CCM.0b013e3181de18bc
更新日期:2010-06-01 00:00:00
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更新日期:1978-09-01 00:00:00
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doi:10.1097/01.ccm.0000158517.25962.8e
更新日期:2005-04-01 00:00:00
abstract::Gastric mucosal damage produced by topical application of necrotizing agents is diminished by topical or systemic pretreatment with a variety of E and F prostaglandins. The rat restraint model of gastric mucosal injury is more analogous to clinical stress ulceration than are models using intragastric application of to...
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pub_type: 杂志文章
doi:10.1097/00003246-198901000-00011
更新日期:1989-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To compare urea nitrogen removal by continuous hemodiafiltration vs. functional native kidneys in critically ill, septic patients receiving > 2 g of amino acids/kg body weight per day. DESIGN:Prospective, comparative, unblinded study. SETTING:Trauma critical care units of a Level I adult trauma hospital. P...
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更新日期:1994-03-01 00:00:00
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更新日期:2016-03-01 00:00:00
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更新日期:1998-08-01 00:00:00
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更新日期:2019-03-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-07-01 00:00:00
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doi:
更新日期:1981-07-01 00:00:00
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更新日期:2020-10-01 00:00:00
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更新日期:2000-10-01 00:00:00
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更新日期:1978-11-01 00:00:00
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更新日期:2011-06-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
doi:
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