Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.
Highlights
The first dedicated pediatric intensive care unit (PICU) was established in Europe in 1955, and pediatric intensive care has only been established as a distinct specialty since 1981 [1]
The downstream effects of adverse emotional outcomes on trajectory of post-intensive care syndrome in pediatrics” (PICs-P) recovery have not been well elucidated, but there is evidence to suggest that more children with psychiatric morbidity after discharge are re-admitted with physical complaints in the following 6-12 months [70]
A prospective randomized trial of early vs. late parenteral nutrition (PN) in the PICU demonstrated that the use of PN in the first week of admission may contribute to limited, adverse neurocognitive outcomes at 2 years follow-up and adverse emotional and behavioral outcomes at 4 years follow-up [109,110]
Summary
The first dedicated pediatric intensive care unit (PICU) was established in Europe in 1955, and pediatric intensive care has only been established as a distinct specialty since 1981 [1]. Advances in the care of critically ill children have resulted in significant improvements in mortality [2,3,4,5,6]. Pediatric critical care research over the last 20 years has increasingly focused on understanding this evolving, diverse population and their outcomes beyond the PICU (Figure 1) [20]. This research has revealed that PICU survivors experience a constellation of post-intensive care morbidities that can significantly impact their longterm outcomes. In this narrative review, we describe the epidemiology of the post-intensive. OdruigalinfualllC-toexptysrcigrehetn©in2g0o21f tbhye trheemSaoinciientgyaorftiCclreitsic[2a0l ]C. aRreepMrinedteidcinweitahnadptphreoWproiartled pFeerdmerisastiioonn ofrfoPmedWiaotrltiecrIsnKtelnuswiveer.anOdriCgirnitaicl aCloCpayrreigShoct i©eti2e0s2. 1 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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