Clinical Experience in Delivering Early Rehabilitation During Intensive Care for Children with Burn Trauma

Critical care survivors may experience a combination of physical, emotional, cognitive, and social impairments, collectively known as post intensive care syndrome (PICS) in pediatrics, which makes it difficult for patients to recover to premorbid levels. Rehabilitation in intensive care (rehabilitation) is aimed at the prevention and treatment of the initial manifestations of PICS in the intensive care unit. Early initiation of rehabilitation plays a key role in the recovery process of patients undergoing intensive care for a long time. Unfortunately, this tactic is of little use to patients with severe burns. Burns are injuries caused by high-temperature, chemical, electrical, or radiation exposure to the body, which damages the skin and underlying tissues. With extensive thermal burns, a clinically pronounced general reaction of the body develops — burn disease, — and the functions of various organs and systems are disrupted. Burn disease has a certain cyclical course. According to the periodization adopted in the Russia, there are four periods of burn disease, each of which has its own manifestations and requires special treatment. Convalescence is the final period of burn disease, which begins after the restoration of the skin and lasts for several weeks and months before the restoration of the morphofunctional state of various organs and systems after a severe burn injury. It is during this period that rehabilitation is possible in severely burned children at the intensive care stage, however, it is difficult to carry out a full range of treatment strategies in patients with this pathology, taking into account the damage to the skin and the unacceptability of some treatment methods. The article presents the experience of rehabilitation by a multidisciplinary rehabilitation team (all staff of the Intensive Care Unit, neurologists, physiotherapists, physical therapy instructors, speech therapists, psychologists) in severely malnourished children. Despite the objective difficulties in carrying out rehabilitation measures, the accumulated experience convinces us of the need to find new opportunities for this category of patients in the form of an earlier start (prerehabilitation).