Functional Recovery Following Critical Illness in Children

Abstract

Objective To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children. Design Prospective pilot study. Setting Single center Pediatric Intensive Care Unit (PICU) at McMaster Children’s Hospital, Hamilton, Canada. Patients Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed-rest during the first 48 hours of PICU admission, and a minimum 48 hour PICU length of stay, were eligible. Patients transferred from a neonatal intensive care unit prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study were excluded. Measurements The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory (PEDI), and the Participation and Environment Measure for Children and Youth (PEM-CY). Main results Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, follow-up rates 93% at 3 months, and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status, and severity of illness. Conclusion Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory, and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multi-center study evaluating functional recovery in this population.

Body Composition Changes in Severely Burned Children During ICU Hospitalization*

“…Chong et al showed that 30% of pediatric ICU patients develop weakness in the ICU [25], and older children have been found to be more affected by muscle wasting than younger ones [26]. Given that the average age of the current study population was relatively young, at a mean of 10 years, the results of this study would be expected to be less affected by the effects of a wide age range.…”

Early mobilization in the critical care unit: A review of adult and pediatric literature

“…As previously described, a recent pediatric pilot study predicted ICU-AW in 30% of patients and confirmed ICU-AW in 6.7% of at-risk patients [23]. Diagnosis of ICU-AW in children is hindered by the lack of a suitable diagnostic tool [23].…”

“…In a recent pediatric pilot study, ICU-AW was confirmed in 6.7% of "at-risk" patients and suspected in 30% [23]. Intensive care unit-acquired weakness is age dependent, with 0.7% of very young children and 5.1% of older children exhibiting muscle weakness [23,24].…”

“…Diagnosis of ICU-AW in children is hindered by the lack of a suitable diagnostic tool [23]. The Medical Research Council (MRC) grading tool is unreliable and unfeasible in children, and handheld dynamometry is best used as a simple screening tool for ICU-AW in alert patients [23,66].…”

Transforming PICU Culture to Facilitate Early Rehabilitation

“…27 The reported incidence of PICU-acquired weakness from prospective studies varies from 1.7 to 30%. 28,29 Its significance and impact on functional recovery and long-term outcomes remains unclear, and is a growing area of interest in critically ill children. 30 …”