EARLY REHABILITATION IN CRITICALLY ILL CHILDREN

Authors

  • S ALI Pediatrics Department, Tehsil Head Quater Hospital Kabal Swat KPK, Pakistan
  • MS IBRAHIM Saidu Group of Teaching Hospitals Saidu Sharif Swat, Pakistan
  • N ALI Paediatrics Oncology, Shaukat Khanum Memorial Cancer Hospital Lahore, Pakistan
  • SA SHAH Paediatric Gastroenterology, Hepatology and Nutrition, Paeds Gastro Unit, Combined Military Hospital Rawalpindi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1084

Keywords:

Critically Ill Children, Early Rehabilitation, Quality Of Life, Pediatric Intensive Care Unit

Abstract

Early rehabilitation interventions in critically ill children admitted to the Pediatric Intensive Care Unit (PICU) have shown potential to improve functional outcomes and recovery. Despite growing interest, there is limited evidence of their efficacy in pediatric populations. Objective: To evaluate the impact of early rehabilitation interventions on clinical outcomes, functional status, respiratory function, muscle strength, and quality of life in critically ill children admitted to the PICU. Methods: This randomized controlled trial was conducted in the Department of Pediatrics, Saidu Teaching Hospital, Saidu Sharif, Swat, Pakistan, from October 2023 to March 2024. A total of 230 critically ill children of both genders were enrolled and randomly assigned to two groups: Group A (n=115) received early rehabilitation interventions within 48 hours of PICU admission, and Group B (n=115) served as the control group. The primary outcomes were PICU length of stay, mortality, functional status, respiratory function, muscle strength, and quality of life. Data were analyzed using SPSS, with significance set at p<0.05. Results: The mean age of patients was 8.60±4.46 years. Group A had a shorter PICU stay (4.69±1.43 days) than Group B (5.00±1.42 days), with a significant p-value of 0.00. Mortality in Group A was 7.8% compared to 15.7% in Group B (p=0.06). Functional status improvement was higher in Group A (62.7%) versus Group B (37.3%) (p=0.00). Respiratory function improved in 73.9% of Group A versus 60.9% of Group B (p=0.03). No significant difference was found in muscle strength improvement (p=0.23). Quality of life improved significantly in Group A (51.3%) compared to Group B (28.7%) (p=0.00). Conclusion: Early rehabilitation interventions significantly improve functional outcomes, respiratory function, and quality of life in critically ill children admitted to the PICU. These findings suggest that incorporating early rehabilitation into standard PICU care may enhance recovery and reduce long-term disability in pediatric patients.

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References

Ong C, Lee JH, Leow MK, Puthucheary ZA. Functional outcomes and physical impairments in pediatric critical care survivors: a scoping review. Pediatric Critical Care Medicine. 2016;17(5):e247-e59.

Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, et al. Life after critical illness in children—toward an understanding of pediatric post-intensive care syndrome. The Journal of pediatrics. 2018;198:16-24.

Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Critical care medicine. 2011;39(2):371-9.

Namachivayam P, Shann F, Shekerdemian L, Taylor A, van Sloten I, Delzoppo C, et al. Three decades of pediatric intensive care: Who was admitted, what happened in intensive care, and what happened afterward. Pediatric Critical Care Medicine. 2010;11(5):549-55.

Cremer R, Leclerc F, Lacroix J, Ploin D, Group GRCDiPS. Children with chronic conditions in pediatric intensive care units located in predominantly French-speaking regions: Prevalence and implications on rehabilitation care need and utilization. Critical care medicine. 2009;37(4):1456-62.

Choong K, Tran N, Clark H, Cupido C, Corsi DJ. Acute rehabilitation in critically ill children. Journal of Pediatric Intensive Care. 2012;1(04):183-92.

Edwards JD, Houtrow AJ, Vasilevskis EE, Rehm RS, Markovitz BP, Graham RJ, et al. Chronic conditions among children admitted to US pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay. Critical care medicine. 2012;40(7):2196-203.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJ, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical care medicine. 2018;46(9):e825-e73.

Smith HA, Besunder JB, Betters KA, Johnson PN, Srinivasan V, Stormorken A, et al. 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatric Critical Care Medicine. 2022;23(2):e74-e110.

Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PloS one. 2019;14(10):e0223185.

Okada Y, Unoki T, Matsuishi Y, Egawa Y, Hayashida K, Inoue S. Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis. Journal of intensive care. 2019;7:1-9.

Miura S, Wieczorek B, Lenker H, Kudchadkar SR. Normal baseline function is associated with delayed rehabilitation in critically ill children. Journal of intensive care medicine. 2020;35(4):405-10.

Nair V, Smith H. Phased quality improvement interventions in reducing unplanned extubation in the neonatal ICU. Respiratory Care. 2020;65(10):1511-8.

Johnson J, Mathew P. Effectiveness of Aerobic Exercise on Peak Expiratory Flow Rate, Exercise Capacity and Quality of Life in Post COVID-19 Patients.

Garcia-Perez-de-Sevilla G, Pinto BS-P. Effectiveness of physical exercise and neuromuscular electrical stimulation interventions for preventing and treating intensive care unit-acquired weakness: a systematic review of randomized controlled trials. Intensive and Critical Care Nursing. 2023;74:103333.

Bhutta AH. THE EFFECTIVENESS OF MUSCLE ENERGY TECHNIQUE AND HAMSTRING NORDIC LOWER IN HAMSTRING TIGHTNESS AMONGST YOUNG ATHLETES OF PAKISTAN”. 2023.

Lang JK, Paykel MS, Haines KJ, Hodgson CL. Clinical practice guidelines for early mobilization in the ICU: a systematic review. Critical Care Medicine. 2020;48(11):e1121-e8.

Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet. 2009;373(9678):1874-82.

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Published

2024-09-04

How to Cite

ALI , S., IBRAHIM , M., ALI , N., & SHAH , S. (2024). EARLY REHABILITATION IN CRITICALLY ILL CHILDREN. Biological and Clinical Sciences Research Journal, 2024(1), 1084. https://doi.org/10.54112/bcsrj.v2024i1.1084

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