Transforming PICU Culture to Facilitate Early Rehabilitation

Hopkins, Ramona O.; Choong, Karen; Zebuhr, Carleen; Kudchadkar, Sapna R.

doi:10.1055/s-0035-1563547

Cited by 71 publications

(42 citation statements)

References 94 publications

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“…The sequelae of PICS can lead to reduced quality of life and functional impairments, in addition to increased societal costs[30-32]. Major differences between children and adults with regard to the implications of PICS include increased years of survival with morbidity after critical illness and the complex nature of interactions between PICS and the developing brain.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Herrup

Wieczorek

Kudchadkar

2017

WJCCM

127

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AIMTo synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome (PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODSA comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit (PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis.RESULTSNineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine and narcotic administration.CONCLUSIONPICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

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Section: Discussionmentioning

confidence: 99%

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Herrup

Wieczorek

Kudchadkar

2017

WJCCM

127

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“…Similar to adult efforts, complementary data to support the optimization of sleep hygiene, nutrition, and sleep and sedation and other supportive care should be incorporated to achieve the most comprehensive approach and impact 41,47 .…”

Section: Discussionmentioning

confidence: 99%

Physical and occupational therapy utilization in a pediatric intensive care unit

Cui

LaPorte

Civitello

et al. 2017

Journal of Critical Care

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Purpose To characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). Materials and Methods We studied children aged 1 week – 18 years admitted to a tertiary care PICU for ≥ 3 days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome. Results Of 138 children studied, 40 (29%) received PT and OT consultation. Services were initiated 6.9 ± 10.0 (mean ± standard deviation) days after PICU admission. Range of motion (83%) was the most common therapy provided and 28% of patients were ambulated. Sixty-four of 297 (21.5%) sessions were deferred and 7 (2.4%) sessions were terminated early due to physiologic instability with no serious adverse events. Children who received PT and OT were older, more likely to require neuromuscular blocking agents, and had lower pre-PICU POPC scores (all p<0.05). Conclusions Data are needed to inform on the efficacy of rehabilitative therapies initiated in the ICU to improve outcome for critically ill children.

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“…Such patients may initially have suffered from severe infection, multiple trauma injuries, heart failure and other diseases leading to multiple organ failure that requires intensive or emergency treatment. In recent years, intensive care medicine has seen a culture change in that the focus on improving survival rates has been expanded to include long-term health-related quality of life after discharge 3 . Health disorders seen in patients, collectively referred to as post intensive care syndrome, include persistent impairments across physical, psychiatric and cognitive domains 4 .…”

Section: Introductionmentioning

confidence: 99%

Visuo-acoustic stimulation that helps you to relax: A virtual reality setup for patients in the intensive care unit

Gerber

Jeitziner

Wyss

et al. 2017

Sci Rep

122

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After prolonged stay in an intensive care unit (ICU) patients often complain about cognitive impairments that affect health-related quality of life after discharge. The aim of this proof-of-concept study was to test the feasibility and effects of controlled visual and acoustic stimulation in a virtual reality (VR) setup in the ICU. The VR setup consisted of a head-mounted display in combination with an eye tracker and sensors to assess vital signs. The stimulation consisted of videos featuring natural scenes and was tested in 37 healthy participants in the ICU. The VR stimulation led to a reduction of heart rate (p = 0. 049) and blood pressure (p = 0.044). Fixation/saccade ratio (p < 0.001) was increased when a visual target was presented superimposed on the videos (reduced search activity), reflecting enhanced visual processing. Overall, the VR stimulation had a relaxing effect as shown in vital markers of physical stress and participants explored less when attending the target. Our study indicates that VR stimulation in ICU settings is feasible and beneficial for critically ill patients.

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Transforming PICU Culture to Facilitate Early Rehabilitation

Cited by 71 publications

References 94 publications

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Physical and occupational therapy utilization in a pediatric intensive care unit

Visuo-acoustic stimulation that helps you to relax: A virtual reality setup for patients in the intensive care unit

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