P0063 / #979: Physical Rehabilitation in Critically Ill Children: A European Point Prevalence Study

The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.

Section: Discussionsupporting

confidence: 90%

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Wollny

Metcalfe

Benzies

et al. 2022

“…16 Other studies have shown that family presence has many other benefits such as positive association with early mobility in critically ill children, which is also associated with better outcomes. 17,18 Our results showed that changes in visiting policies during the COVID-19 pandemic have been more homogeneous across the continents and have been enforced in around 50% of studied units worldwide. Restrictions in visitation policies have been shown to have detrimental effects not only on patients 19 but also on families and HCWs, 20 who reported higher levels of stress and anxiety also due to visitation restrictions 21 (►Fig.…”

Section: Discussionmentioning

confidence: 66%

Impact of COVID-19 Pandemic on Pediatric Intensive Care Unit Visiting Policies: A Worldwide Survey

Camporesi

Zanin

Kanaris

et al. 2021

The purpose of this study was to evaluate pediatric intensive care unit (PICU) visiting policies around the world and how the coronavirus disease 2019 (COVID-19) pandemic has affected these policies, due to concerns relating to a viral transmission. A web-based international survey was designed and disseminated through social networks, emails, or direct messages. Two hundred forty-one answers were received. From these, 26 were excluded (13 due to missing location and 13 duplicated answers), resulting in a final number of 215 answers. Europe accounted for 35% of responses (n = 77), South America 22.4% (n = 49), North America 19% (n = 41), Asia 16.5% (n = 36), Central America 2.7% (n = 6), Oceania, and Africa 2.2% each (n = 5 each). Before the pandemic, reported admission/visiting policies already varied between continents. Family time schedules remained similar to the pre-pandemic period in half of European, Central, and South American units and have changed in 60% of Asian, African, North American, and Oceanian units. Access to PICUs has been granted for patients and caregivers tested negative for severe acute respiratory syndrome coronavirus 2 (SARS COV-2) in only part of studied PICUs. Isolation precautions for the visitors were intensified at the onset of the pandemic. Changes in visiting policies were observed in most PICUs worldwide during the COVID-19 pandemic, with some PICUs prohibiting any visitation by families. These changes can decrease possibilities of parental participation in emotional support and reduction of sedation needs, early mobility, and shared decision-making process and impact negatively both children and parental well-being and even patients' outcomes.

“…Of 209 potentially eligible patients during the study period, 87 were excluded due to having only one PAMS score documented. The cohort of excluded patients had a shorter median hospital LOS (7 [5-9.5] vs 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] days, p < 0.001), likely accounting for lack of more than one PAMS score, as patients were scored once per week, and none of these patients were discharged to an IRF. There were 122 patients included in the final study cohort and they are described in ►Table 1.…”

Section: Demographicsmentioning

confidence: 99%

“…[14][15][16][17][18] Recent point prevalence studies have also demonstrated a need for more systematic rehabilitation interventions for critically ill children. [19][20][21] However, as implementation of these protocols increases in the PICU, it is important to accurately assess changes in patient functional status, but there are currently few validated tools with sufficient granularity to adequately track functional motor changes. Even measuring functional progress after discharge has been limited due to the use of a variety of scoring systems across varied child developmental levels, which limits the sharing of data.…”

Section: Introductionmentioning

confidence: 99%

The Physical Abilities and Mobility Scale as a New Measure of Functional Progress in the PICU

Weatherly

Wang

Lindsell

et al. 2021

Assessing functional motor changes and their relationship to discharge needs in the pediatric intensive care unit (PICU) population is difficult given challenges quantifying small functional gains with current tools. Therefore, we compared the Physical Abilities and Mobility Scale (PAMS) to the Functional Status Scale (FSS) in PICU patients to assess correlation and differences and association with discharge needs. This study was a retrospective chart review of all patients (2–18 years old) admitted to the PICU and cardiac PICU for over 9 months who received early mobility services, including PAMS and FSS scoring. Correlation between scales, relationship of scores to disposition, and logistic regression model of changes in PAMS in relation to disposition were determined. Data were obtained for 122 patients. PAMS and FSS scores strongly negatively correlated (Spearman's ρ = − 0.85), but with a nonlinear relationship, as the PAMS more readily differentiated among patients with higher functional status. The median FSS at discharge was 12.5 for those recommended an inpatient rehabilitation facility (IRF) (n = 24), versus 9 for those recommended discharge home (n = 83, Δ 3.5, 95% confidence interval [CI]: 1–6, around one-tenth of FSS scale). The corresponding median PAMS were 42 and 66 (Δ 24, 95% CI: 10–30, one-fourth of PAMS scale). Although not statistically significant, a logistic regression model was consistent with patients who showed modest change in PAMS across hospitalization but persistent deficits (PAMS < 60) were more likely to be recommended an IRF. The PAMS correlates to the FSS, but appears more sensitive to small functional changes, especially in higher functioning patients. It may be useful in prognosticating discharge needs.