Pediatric Rehabilitation and Critical Care: a Therapeutic Partnership
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Purpose of review
The number of children in intensive care units (ICU) who survive critical illness or injury is increasing. Reduction of complications and improvement in outcome may be facilitated by early rehabilitation-oriented interventions and transition to an intensive pediatric rehabilitation unit when medically appropriate.
Early mobilization in the adult ICU has been identified as a contributing factor to improving outcomes. This intervention is being introduced in pediatric ICUs and practice guidelines for implementation are being developed. Timely and coordinated transfers to a pediatric intensive rehabilitation unit to continue functional recovery and to prepare for community reintegration are also important to providing optimal care.
Introducing rehabilitation input and practices into the pediatric ICU environment is feasible and safe. A coordinated process for moving patients from the pediatric ICU to an intensive rehabilitation unit requires clear communication with families about expected goals and expectations.
KeywordsChildren Critical care Intensive care Rehabilitation Early mobilization Transition
Compliance with ethical standards
Conflict of interest
Frank Pidcock declares no conflicts of interest relevant to this manuscript.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011;39:371–9 Database search that identifies long-term issues associated with ICU survival. Neuromuscular weakness and impairments in physical function and related quality of life indicators were seen as common problems that may be long lasting. CrossRefGoogle Scholar
- 4.• Wieczorek B, Burke C, Al-Harbi A, Kudchadkar SR. Early mobilization in the pediatric intensive care unit: a systemic review. J Pediatr Intensive Care. 2015;2015:129–70 Review of pediatric ICU literature. Synthesis of the six articles that met search criteria indicated that early rehabilitation in the PICU setting was safe, feasible, and had potential short- and long-term benefits. Google Scholar
- 5.•• Choong K, Koo KY, Clark H, et al. Early mobilization in critically ill children: a survey of Canadian practices. Crit Care Med. 2013;41:1745–53 Survey study that identified perceived institutional, patient, and physician biases against early mobilization in pediatric intensive care units. CrossRefGoogle Scholar
- 6.•• Wieczorek B, Ascenzi J, Kim Y, et al. PICU up!: impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med. 2016;17(12):e559–66 An implementation study of a structured and stratified early mobilization program in the PICU. It showed that early mobilization was feasible and safe. It describes the components of a model program. CrossRefGoogle Scholar
- 12.Cremer R, Leclerc F, Lacroix J, Ploin D. GFRUP/RMEF chronic disease in PICU study group: children with chronic conditions in pediatric intensive care units located in predominantly French-speaking regions: prevalence and implications on rehabilitation care needs and utilization. Crit Care Med. 2009;37:1456–62.CrossRefGoogle Scholar
- 13.•• Roscigno CI, Grant G, Savage TA, et al. Parent perceptions of early prognostic encounters following children’s severe traumatic brain injury: “locked up in this cage of absolute horror”. Brain Inj. 2013;27(13–14):1536–48 An interview study of 29 parents of PICU survivors that identified parental reaction to the manner in which information is provided in the PICU setting. Conveying uncertainty in prognosis and focusing solely on negative outcome prediction were seen as a barrier to effective communication. CrossRefGoogle Scholar
- 15.Abdulsatar F, Walker RG, Timmons BW, et al. “Wii-Hab” in critically ill children: a pilot trial. J Pediatr Rehabil Med. 2013;6(4):193–204.Google Scholar