Early Mobility in Pediatric Critical Care

Interview with Dr. Karen Choong

Dr. Karen Choong is an Associate Professor in the Department of Pediatrics at McMaster University and an associate member of the Department of Clinical Epidemiology & Biostatistics. She joined the Division of Critical Care in the Department of Pediatrics at McMaster in 2003.

Dr Choong has a clinical research focus and holds several peer-reviewed research grants as a principal investigator. Her current research focus is on acute rehabilitation in critically ill children.

Tell us a little about your background and how you came to be working with pediatric in critical care.

I received my medical training at the Royal College of Surgeons in Ireland, followed by pediatric residency training at Queen's University, Kingston, Ontario. I find working with critically ill children particularly satisfying. Patients in the ICU experience organ failure or the potential for organ failure, and are at risk of prolonged immobility.

Tell us about the work you are doing in the McMaster Children's Hospital.

I am a member of the ICU team treating patients with medical or surgical needs. I am also a member of the rapid response team that provides advice and assistance to the wards and to other hospitals in the region. My clinical role complements my research focus which is on acute rehabilitation in critically ill children.

What do you see as the critical issues that you are seeking to address specifically for the children who have to spend a long time in a critical care bed?

Children, like adults, are at risk of ICU-acquired morbidities is more accurate. These include muscle wastage, delirium, and increased secondary infections. The longer patients are immobilized the greater their potential to develop these morbidities, which can last even after their discharge from the PICU.

How is the RT300 Supine cycle ergometer able to assist you to address these issues?

The supine cycle is one of a number of rehabilitation tools that are currently being used in the ICU. We are hoping that it will help prevent muscle wasting, and have direct and indirect benefits to these patients. Research with adults has shown early promise of patient benefits from the use of supine cycling, and we are currently recruiting patients for a pediatric study.

What benefits have you seen in children who have had the opportunity to use the supine system, and can you give some examples of patient outcomes?

It is too early to talk about the beneficial outcomes as we have only just commenced the study. The reason we are undertaking such a study is because we hypothesize that there are potential important benefits.

What would you say to other clinicians who are contemplating using a supine system with children in critical care facilities?

We are just learning how to use this in the pediatric population, and tailoring the design of the supine system to their needs. Hence, there is much research that is needed in children before we can recommend this widely in other PICUs. We hope to understand through our research who – ie. which type of patient may benefit most from this intervention, how – ie the most appropriate timing and intensity of cycling for critically ill children, and if indeed it can improve important patient outcomes.

Do you have any other comments about RT300 Supine cycle ergometer and/or Restorative Therapies?

Collaboration with Restorative Therapies has been excellent particularly from the clinical support team.

How have children responded to using the supine system?

Children and parents generally like the idea of bedridden patients being able to exercise while in bed, however it is important to get their “buy in” and address any concerns they might have before starting the program. Some patients say that it is “cool” and are excited about being able to be active whilst in bed. The level of engagement of children is variable, because it depends on many things, such as their cognitive and functional capacity, as well as their disease process.