Muscle Changes in Critically Ill Children Following an Early Progressive Exercise in the Paediatric Intensive Care Unit: A Pre- and Post-Intervention Study.

BACKGROUND

Most critically ill children in the paediatric intensive care unit (PICU) are immobilised. Prolonged immobilisation in the PICU negatively affects children's physical health outcomes.

AIM: The aim of the study was to evaluate the effectiveness of an early progressive exercise (EPE) intervention to improve the PICU-acquired muscle weakness and to assess the safety of the EPE intervention.

STUDY

DESIGN

A single-centre pre- and post-intervention design was adopted. The intervention was the EPE starting within 48-72 h after PICU admission. Primary outcome was the 7-day difference of right rectus femoris muscle cross-sectional area (RRMCSA). Secondary outcomes were the 7-day difference of right rectus femoris muscle thickness (RRMT), the 7-day difference of the right thigh leg circumference, length-of-stay, functional status score (FSS) and the incidence of intervention-related adverse events.

RESULTS

Included were 29 children in the pre-intervention group and 32 children in the post-intervention group who did not require mechanical ventilation during PICU admission. The 7-day difference of RRMCSA in the post-intervention group was smaller than in the pre-intervention group, (-0.13 ± 0.13 cm2 versus -0.28 ± 0.10 cm2, p < 0.001). The RRMT at 7-day was also smaller in the post-intervention group (-0.08 ± 0.09 cm versus -0.23 ± 0.08 cm, p < 0.001). FSS of the post-intervention group was significantly lower than that of the pre-intervention group (p < 0.05). Differences in right thigh circumference, and length-of-stay were not observed between both groups. Children in the post-intervention group completed a total of 224 exercise sessions (completion rate 99.2%). No adverse events were observed.

CONCLUSIONS

EPE slowed muscle atrophy and was safe and feasible in children without mechanical ventilatory support in the PICU. Further research needs to confirm early rehabilitation on short-term and long-term physical health outcomes after PICU discharge.

RELEVANCE TO CLINICAL PRACTICE: PICU nurses should consider using early progressive exercise in critically ill children in the PICU and have parents involved in these early rehabilitation programmes.

TRIAL REGISTRATION: Chinese Clinical Trial Registry https://www.chictr.org.cn/indexEN.html number: ChiCTR2100047629.