Functional Recovery in Critically Ill Children
Intensive Care Unit-acquired weakness (ICU-AW) is a well-recognized, important and preventable sequelae of critical illness, affecting up to 60% of adult ICU patient. ICU-AW is associated with increased mortality and length of stay, and negatively impacts long-term functional outcomes and quality of life in affected patients and their caregivers. While delayed mobilization adversely affects clinical outcomes, early rehabilitation in the critically ill adult population is safe, feasible, cost effective, results in more ventilator free-days and better functional outcomes at hospital discharge. In contrast, there is a paucity of this research in pediatrics. Our research suggests that immobilization is common in critically ill children, and rehabilitation is delayed particularly in the sickest children who are arguably at highest risk of morbidity. It is unclear however, whether delayed rehabilitation leads to adverse outcomes in critically ill children, as has been demonstrated in adults. Our objectives of this study are to evaluate if immobilization and delayed rehabilitation negatively impacts short-term clinical outcomes and the time to functional recovery in critically ill children. The investigators hypothesize that the following factors may influence functional recovery and morbidity in critically ill children:
- Pre-morbid condition
- Time-to-initiation of acute rehabilitation
- Critical illness disease severity
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Functional Recovery in Critically Ill Children - the Wee-Cover Pilot Study|
- Feasibility [ Time Frame: 12 months ] [ Designated as safety issue: No ]Feasibility will be determined by the consent and enrolment rate, and the protocol adherence and follow-up rates.
- Functional Recovery [ Time Frame: Baseline, 3 and 6 month follow-up ] [ Designated as safety issue: No ]Functional Recovery will be measured by the following standardized, validate pediatric assessment tools of function, as defined by the International Classification of Functioning, Disability and Health (ICF): 1) Pediatric Evaluation of Disability Inventory (PEDI); 2) Participation and Environment Measure - children and youth version (PEM-CY), and preschool version; 3) Pediatric Overall Performance Category score (POPC); 4) Pediatric Cerebral Performance Category Score (PCPC)
- Pediatric Critical care Unit (PCCU) clinical outcomes [ Time Frame: at 30 days and duration of hospitalization ] [ Designated as safety issue: No ]PCCU outcomes will be assessed by the following: Ventilator-free days, PCCU mortality, length of PCCU and hospital stay, and the incidence of PCCU-acquired weakness
- Muscle Strength [ Time Frame: Hospital discharge and at 3 and 6 month follow-up ] [ Designated as safety issue: No ]
In an age-appropriate subgroup, the following measurements will be conducted:
- Muscle Strength and aerobic fitness testing (age ≥ 5 years, and/or able to cognitively and physically comply with strength and fitness tests)
- Measurement of muscle strength using BIODEX and hand grip strength, and assessment of lean mass (Bioelectrical impedance analysis)
- Parental or caregiver stress [ Time Frame: 3 month follow-up ] [ Designated as safety issue: No ]Parental or caregiver stress will be measured with the Parental Stress Index (PSI)
- Feasibility and reliability of screening for PCCU-acquired weakness [ Time Frame: Duration of Hospitalization, 3 and 6 months follow-up ] [ Designated as safety issue: No ]The most appropriate method of screening and diagnosing PCCU-acquired weakness has not been well established given the many challenges in ascertainment in this population. Hence, one of the objectives of this study is to determine whether manual muscle strength testing is a feasible and reliable method of screening for this important disorder in the critically ill pediatric population. Muscle strength will be quantified clinically using the (MRC) score by 2 independent assessors. For a subset of age appropriate (≥ 4 years), we will determine their hand-grip strength using a hand dynamometer or Martin Vigorimeter, depending on their age.
|Study Start Date:||October 2012|
|Study Completion Date:||November 2013|
|Primary Completion Date:||November 2013 (Final data collection date for primary outcome measure)|
Overall Study objectives:
- To describe the functional recovery following prolonged immobility and delayed rehabilitation in critically ill children.
- To explore the predictors of impaired functional recovery following immobilization in critically ill children.
Prior to conducting a definitive multi-centre study to answer our research questions and achieve our study objectives above, we will conduct a pilot study in order to demonstrate feasibility.