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Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial.


ABSTRACT: OBJECTIVE:s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN:Randomized controlled trial. SETTING:Three tertiary care PICUs in the United States. PATIENTS:Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. INTERVENTIONS:Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72?hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). MEASUREMENTS AND MAIN RESULTS:Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4?±?0.8 versus 7.7?±?4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3?±?0.6 versus 6.9?±?4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3?±?0.7 versus 13.0?±?10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p < 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. CONCLUSIONS:A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.

SUBMITTER: Fink EL 

PROVIDER: S-EPMC7112470 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial.

Fink Ericka L EL   Beers Sue R SR   Houtrow Amy J AJ   Richichi Rudolph R   Burns Cheryl C   Doughty Lesley L   Ortiz-Aguayo Roberto R   Madurski Catherine A CA   Valenta Cynthia C   Chrisman Maddie M   Golightly Lynn L   Kiger Michelle M   Patrick Cheryl C   Treble-Barna Amery A   Pollon Dorothy D   Smith Craig M CM   Kochanek Patrick P  

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20190601 6


<h4>Objective</h4>s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients.<h4>Design</h4>Randomized controlled trial.<h4>Setting</h4>Three tertiary care PICUs in the United States.<h4>Patients</h4>Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult  ...[more]

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