Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

Abstract

AIMTo synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome (PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODSA comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit (PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis.RESULTSNineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine and narcotic administration.CONCLUSIONPICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Fast and slow thinking; and the problem of conflating clinical reasoning and ethical deliberation in acute decision‐making

“…This approach is supported by the evidence suggesting that developed world PICUs have a less than 3% mortality rate . What has been less studied until recently, however, is the burden of lifelong disability some families then manage indefinitely post discharge, perhaps due in part to this mode of decision‐making …”

“…30 What has been less studied until recently, however, is the burden of lifelong disability some families then manage indefinitely post discharge, perhaps due in part to this mode of decision-making. 31 Advances in medical technology and expectations of access to it have fostered a technocratic paradigm in clinical decisionmaking, 32 and while there is no doubt families undertake this task selflessly and enduringly, the ability of expert clinicians to pause and acknowledge the prevalence of these biases is crucial. Initiating slow System 2 thinking earlier in the acute decisionmaking pathway, rather than reflexively adopting a type of 'clinico-ethical substitutive' thinking, 34 may allow a more realistic account of the lifelong burdens of medical interventions, such as long-term ventilation, that these children and their families knowingly or unknowingly undertake.…”

Langzeitfolgen des Intensivaufenthalts

“…Auch tägliche Aktivitäten erleben Angehörige als schwierig. Nicht nur erwachsene kritisch kranke Patienten und deren Angehörige leiden unter einem PICS, vermehrt wendet sich die Literatur auch Kindern (PICS-p) nach einem ICU-Aufenthalt einer Angehörigen zu [22].…”

Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

“…While delirium affects patients during their ICU admission, a strong foundation of evidence on sequelae of ICU survivorship in adults has led to the definition of post-intensive care syndrome, or PICS (86). PICS is defined as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond hospitalization.” A systematic review by Herrup et al synthesizing the available pediatric evidence on morbidities within the construct of PICS found nineteen studies which encompassed the characteristics of PICS, including nine studies on psychological morbidity after PICU admission (87). Anxiety and depression, culminating in posttraumatic stress disorder, has been well documented in adult survivors of critical illness (88).…”