Treatment In Pediatric Intensive Care Unit Research Articles

Characteristics and spectrum changes of PICU cases during the COVID-19 pandemic: a retrospective analysis.

This study aims to compare the changes in the disease spectrum of children admitted to the Pediatric Intensive Care Units (PICU) during the COVID-19 pandemic with the three years prior to the pandemic, exploring the impact of the COVID-19 pandemic on the disease spectrum of PICU patients. A retrospective analysis was conducted on critically ill children admitted to the PICU of Hunan Children's Hospital from January 2020 to December 2022, and the results were compared with cases from the same period between January 2017 and December 2019. The cases were divided into pre-pandemic period (January 2017-December 2019) with 8,218 cases, and pandemic period (January 2020-December 2022) with 5,619 cases. General characteristics, age, and gender were compared between the two groups. Compared to the pre-pandemic period, there was a 31.62% decrease in the number of admitted children during the pandemic period, and a 52.78% reduction in the proportion of respiratory system diseases. The overall mortality rate decreased by 87.81%. There were differences in age and gender distribution between the two periods. The length of hospital stay during the pandemic showed no statistical significance, whereas hospitalization costs exhibited statistical significance. The COVID-19 pandemic has exerted a certain influence on the disease spectrum of PICU admissions. Implementing relevant measures during the pandemic can help reduce the occurrence of respiratory system diseases in children. Considering the changes in the disease spectrum of critically ill PICU children, future clinical prevention and treatment in PICUs should continue to prioritize the respiratory, neurological, and hematological oncology systems.

Pediatric intensive care unit treatment alters the diversity and composition of the gut microbiota and antimicrobial resistance gene expression in critically ill children.

Common critical illnesses are a growing economic burden on healthcare worldwide. However, therapies targeting the gut microbiota for critical illnesses have not been developed on a large scale. This study aimed to investigate the changes in the characteristics of the gut microbiota in critically ill children after short-term pediatric intensive care unit (PICU) treatments. Anal swab samples were prospectively collected from March 2021 to March 2022 from children admitted to the PICU of Xinhua Hospital who received broad-spectrum antibiotics on days 1 (the D1 group) and 7 (the D7 group) of the PICU treatment. The structural and functional characteristics of the gut microbiota of critically ill children were explored using metagenomic next-generation sequencing (mNGS) technology, and a comparative analysis of samples from D1 and D7 was conducted. After 7 days of PICU admission, a significant decrease was noted in the richness of the gut microbiota in critically ill children, while the bacterial diversity and the community structure between groups remained stable to some extent. The relative abundance of Bacilli and Lactobacillales was significantly higher, and that of Campylobacter hominis was significantly lower in the D7 group than in the D1 group. The random forest model revealed that Prevotella coporis and Enterobacter cloacae were bacterial biomarkers between groups. LEfSe revealed that two Gene Ontology entries, GO:0071555 (cell wall organization) and GO:005508 (transmembrane transport), changed significantly after the short-term treatment in the PICU. In addition, 30 KEGG pathways were mainly related to the activity of enzymes and proteins during the processes of metabolism, DNA catabolism and repair, and substance transport. Finally, 31 antimicrobial resistance genes had significantly different levels between the D7 and D1 groups. The top 10 up-regulated genes were Erm(A), ErmX, LptD, eptB, SAT-4, tetO, adeJ, adeF, APH(3')-IIIa, and tetM. The composition, gene function, and resistance genes of gut microbiota of critically ill children can change significantly after short PICU treatments. Our findings provide a substantial basis for a better understanding of the structure and function of gut microbiota and their role in critical illnesses.

COMPARED EFFECTIVENESS, SAFETY AND COST OF DEXMEDETOMIDINE WITH MIDAZOLAM: A REVIEW

Dexmedetomidine, an alpha 2 receptor agonist sedative drug, has recently garnered attention as a viable alternative to midazolam, a widely used benzodiazepine for sedation in adult patients. The aim of this study was to conduct a comprehensive comparison of the clinical sedative efficacy, cost-effectiveness, and safety profiles of dexmedetomidine versus midazolam, utilizing a randomized controlled trial design. The search encompassed several databases, including PubMed, Scopus, Web of Knowledge, CINAHL, the United States National Library of Medicine, and Google Scholar for Systematic Reviews, using the keywords 'dexmedetomidine,' 'midazolam,' and 'effectiveness.' The findings revealed that dexmedetomidine demonstrated a more favorable safety profile, with a lower incidence of delirium compared to midazolam. In terms of effectiveness, no significant differences were observed between the two drugs for local sedation. Notably, adult patients treated with dexmedetomidine had a shorter Intensive Care Unit (ICU) stay (7 days) compared to those receiving midazolam (10 days). Similarly, pediatric ICU treatment indicated a shorter duration with dexmedetomidine (20 hours) as opposed to midazolam (38 hours). Regarding cost-effectiveness, dexmedetomidine emerged as a cost-saving option, being approximately 10% cheaper than midazolam for adult ICU patients. These findings collectively highlight the advantages of dexmedetomidine over midazolam, encompassing superior safety, effectiveness, and cost-efficiency, thus providing valuable insights for healthcare practitioners and decision-makers.

PICU treatment of 3 cases of pediatric thyroid storm: Case series and literature review.

Thyroid storm (TS), also known as thyroid crisis, is a life-threatening condition that involves multiple organ dysfunction and high mortality due to uncontrolled hyperthyroidism. TS in children is extremely rare, early diagnosis and treatment can significantly improve the prognosis of the children. Three female children who diagnosed as "thyroid storm" were admitted to Pediatric Intensive Care Unit (PICU). One of them had a family history of hyperthyroidism and others had infection factors induced TS. They presented with characteristic manifestations of TS and were evaluated with Burch-Wartofsky Point Scale (BWPS) hyperthyroidism score. Three cases showed that free triiodothyronine 3 (FT3) and free triiodothyronine 4 (FT4) were increased and Thyroid-Stimulating-Hormone was significantly decreased, which were characteristic in hyperthyroidism. They presented with characteristic manifestations of TS and were evaluated with BWPS hyperthyroidism score. All the cases were given antithyroid drugs (ATDs) for treatment. In addition, 1 of them underwent therapeutic plasma exchange (TPE) after transferring to PICU. One of the cases was declared dead and others were survived. TS should be identified timely and treated early. Further studies are needed to determine the diagnostic criteria and scoring system for TS in pediatric.

Çocuk Yoğun Bakım Ünitesinde İzlenen Hastaların Beslenme Durumu ve Malnütrisyon Değerlendirmesi

Background: Malnutrition, which occurs at the time of hospitalization or develops during follow-up, has a negative effect on patients in pediatric intensive care unit (PICU). In our study, we aimed to determine the malnutrition status at the time of hospitalization, the relationship of malnutrition status at hospitalization with mortality scores, as well as the changes in malnutrition status during hospitalization in PICU. Materials and Methods: Patients aged between 1 month and 18 years, who were hospitalized and followed up in PICU of our hospital for at least 7 days between January and June 2016, were included in our study. Pediatric Nutritional Risk Score (PNRS) scores were compared with Gomez and Waterlow scores when patients were discharged from the PICU. Results: Our study has included total 102 patients, weight loss was detected in 33 (32.3%) of the patients compared to hospitalization, while weight gain was detected in 44 (43.1%) patients. We detected newly developed malnutrition both at the time of admission and during the PICU follow-up. Patients with malnutrition at the time of discharge had a high PNRS score at admission. Conclusions: In conclusion, the malnutrition status and risk situations of patients should be determined and patient-specific nutritional strategies applied from the beginning of treatment in PICU.

Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes

Approximately 23 700 US children undergo invasive mechanical ventilation for acute respiratory failure annually, with unknown long-term effects on neurocognitive function. To evaluate neurocognitive outcomes of children who survive pediatric intensive care unit (PICU) hospitalization for acute respiratory failure compared with their biological siblings. Prospective sibling-matched cohort study conducted at 31 US PICUs and associated neuropsychology testing centers. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and underwent mechanical ventilation. Biological siblings were aged 4 to 16 years at testing, with Pediatric Cerebral Performance Category score of 1 and no history of mechanical ventilation or general anesthesia. A total of 121 sibling pairs were enrolled from September 2, 2014, to December 13, 2017, and underwent neurocognitive testing starting March 14, 2015. The date of the final follow-up was November 6, 2018. Critical illness and PICU treatment for acute respiratory failure. The primary outcome was IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes included measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, and executive function. Evaluations occurred 3 to 8 years after hospital discharge. Patients (n = 121; 55 [45%] female patients) underwent PICU care at a median (IQR) age of 1.0 (0.2-3.2) years, received a median (IQR) of 5.5 (3.1-7.7) days of invasive mechanical ventilation, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years. Matched siblings (n = 121; 72 [60%] female siblings) were tested at a median (IQR) age of 8.4 (7.0-10.2) years. Patients had a lower mean estimated IQ than matched siblings (101.5 vs 104.3; mean difference, -2.8 [95% CI, -5.4 to -0.2]). Among secondary outcomes, patients had significantly lower scores than matched siblings on nonverbal memory (mean difference, -0.9 [95% CI, -1.6 to -0.3]), visuospatial skills (mean difference, -0.9 [95% CI, -1.8 to -0.1]), and fine motor control (mean difference, -3.1 [95% CI, -4.9 to -1.4]) and significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). There were no significant differences in the remaining secondary outcomes, including attention, verbal memory, expressive language, and executive function. Among children, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive dysfunction was associated with significantly lower subsequent IQ scores compared with matched siblings. However, the magnitude of the difference was small and of uncertain clinical importance.

Nosocomial Acinetobacter baumannii infection in children in adult versus pediatric intensive care units.

We hypothesized that children treated in adult intensive care units (ICUs) might be at increased risk of hospital-acquired infection. We therefore compared the incidence of Acinetobacter baumannii infection in children treated in pediatric ICUs (PICUs) and in those treated in adult ICUs. Patients aged <18years admitted to PICUs or adult ICUs between March 2009 and June 2017 were enrolled. We retrospectively investigated A.baumannii isolates and calculated the A.baumannii incidence during ICU admission. Cox regression was used to identify possible risk factors for A.baumannii infection. Eight hundred and thirty ICU cases were included; 508 were treated in PICUs ("PICU group") and 322 in adult ICUs ("adult-ICU group"). Acinetobacterbaumannii was isolated 19 (3.7%) and 23 (7.1%) times in the PICU and adult-ICU groups, respectively. Incidence densities for A.baumannii acquisition in PICU and adult-ICU groups were 1.63 and 5.62 per 1,000 ICU days, respectively. In the Cox regression model, the hazard ratio for A.baumannii acquisition associated with treatment in PICUs was 0.33 (95% confidence interval: 0.17-0.61; P=0.001). In multivariate analysis after adjusting for age and sex, treatment in PICU remained significantly associated with a reduced risk of A.baumannii infection (hazard ratio: 0.40; 95%; confidence interval: 0.20-0.76). Pediatric patients treated in a PICU had a lower rate and incidence density of A.baumannii nosocomial infection than those treated in adult ICUs, suggesting that PICUs provide better infection control for children than adult ICUs.

Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit.

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting). Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer-Lemeshow goodness-of-fit test. Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4-60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories ( p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration. Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

Correlation of complement depletion and the severity of sepsis in children

Objective To analyze the relationship between complement key component C3, C4 and the severity of sepsis in children, in order to explore the role of complement activation in the progression of sepsis and provide a reference for diagnosis and treatment of severe sepsis. Methods Four hundred and twenty-four children diagnosed as sepsis from December 2012 to December 2015 in Children′s Hospital of Nanjing Medical University were enrolled in this study, among whom 347 children with sepsis were eligible for the following research including 169 cases of common sepsis and 178 cases of severe sepsis. Blood specimens were collected in 24 hours after their admission into pediatric intensive care unit(PICU) for the analysis of lymphocyte subsets, humoral immunity, blood routine analysis, coagulation, liver and renal function analysis. General information was collected by consulting their medical records, laboratory analysis and clinical treatment. The relationship between complement C3, C4 and the severity of sepsis was analyzed, and the correlation between C3 and coagulation, liver, renal, myocardium damage was also studied. Logistic regression was used to analyze the relationship between C3 and the progression to severe sepsis and multiple organ dysfunction syndrome(MODS), while Cox regression was used for survival analysis. Results Natural killer(NK) cell percentage was lower in severe sepsis group than that in common sepsis group[6.6%(3.7%, 10.7%) vs. 8.5%(4.7%, 13.3%), Z=2.635, P=0.008], while C3 decreased in severe sepsis group compared with common sepsis group [0.653(0.462, 0.985) g/L vs. 0.991(0.678, 1.265) g/L, Z=5.684, P<0.001], and C4 decreased in severe sepsis group compared with common sepsis group [0.160(0.102, 0.244) g/L vs. 0.190(0.121, 0.265) g/L, Z=2.513, P=0.012]. The proportion of severe pneumonia was higher in severe sepsis group than that in co-mmon sepsis group (34.3% vs. 19.5%, χ2=9.540, P=0.002), and liver function damage proportion was increased in severe sepsis group than that in common sepsis group (48.3% vs. 16.0%, χ2=41.28, P<0.001), and the duration of PICU treatment was longer in severe sepsis group than that in common sepsis group[10.7(6.5, 17.4) d vs. 7.5(4.0, 12.4) d, Z=-4.039, P<0.001]. C3 was significantly decreased in children with single organ dysfunction, multiple organ dysfunction and death group compared with common sepsis group (K=33.04, P=0.001), and the median of each group decreased with the severity of sepsis, but C4 had no difference among 4 groups(K=7.36, P=0.061). C3 was positively correlated with coagulation marker platelet (ρ=0.31, P<0.001) and fibrinogen (ρ=0.53, P<0.001), but negatively correlated with international normalized ratio (INR) (ρ=-0.39, P<0.001) and activated partial thromboplastin time (ρ=-0.34, P<0.001). C3 was also negatively correlated with liver damage marker alanine transaminase (ρ=-0.30, P<0.001) and total bilirubin (ρ=-0.28, P<0.001), and had a negative correlation with renal function marker creatinine (ρ=-0.24, P<0.001) and myocardial damage marker creatine kinase-MB (ρ=-0.27, P<0.001). The depletion of C3 was a risk factor of severe sepsis(OR=3.45, P<0.001) and MODS(OR=3.03, P=0.005) after being adjusted for confounding factors by using Logistic regression. In stratification analysis, C3 depletion was still a risk factor of severe sepsis(OR=2.78, P=0.019) and MODS(OR=3.57, P=0.015) among children less than 1 year old, and was also a risk factor of severe sepsis(OR=4.76, P=0.008) among children more than 1 year old as well. In children without liver function damage, C3 depletion was still a risk factor of severe sepsis(OR=4.17, P=0.002) and MODS(OR=9.09, P=0.002). Cox regression showed that C3 depletion was a hazard in 28-day mortality(HR=3.57, P=0.026) in children with sepsis. Conclusion The decrease of C3 is correlated with coagulation dysfunction and organ damage marker, while C3 depletion was a risk factor of severe sepsis, MODS and 28-day mortality, and could be a potential prognostic marker of children with sepsis. Key words: Sepsis; Severe sepsis; Complement C3; Complement C4

Observational clinical study on organ dysfunction associated with dosing of antibiotics in a Pediatric Intensive Care Unit.

Medication errors are of concern especially in pediatric patients. This study investigates impact of dosing errors of antibiotics on outcome in critically ill pediatric patients. Retrospective study including all consecutive patients admitted to one university pediatric intensive care unit (PICU) in 2010 with length of PICU stay >24 hrs, age <18 years and antibiotic therapy. Antibiotic dosages were evaluated for compliance with recommended dosing individually adapted for bodyweight, age and organ function. Primary endpoint was organ dysfunction defined as occurrence of liver injury (LI) or acute kidney injury (AKI) after initiation of antibiotic therapy. AKI was defined as reduced estimated glomerular filtration below 50 mL/min or renal replacement therapy. LI was defined as more than two-fold elevation of liver enzymes. Additionally, duration of PICU stay, ventilation and all-cause PICU mortality were investigated. Altogether 305 patients were evaluated with 2577 patient PICU days and 4021 antibiotic dosages. Overall 38.6% of dosages were incorrect according to recommendations and were applied in 130 patients (low-adherence-group). 175 children received antibiotic dosing according to recommendations (high-adherence-group). Patients in the low-adherence-group showed a 7-fold increase in adjusted risk to develop new-onset organ dysfunction (95% CI: 2.1-26.4), needed longer median PICU treatment (7 versus 3 days, P<0.001) and prolonged duration of mechanical ventilation (8 versus 2 days, P<0.001). In subgroup analyses, organ dysfunction and PICU mortality were associated with non-adherence to recommendations. Adherence to a bodyweight- and age-adapted dosage-protocol is associated with less organ dysfunction and a more favorable clinical outcome in pediatric patients.

Validation of the Pediatric Early Warning Score to determine patient deterioration from illness

Background Patients who enter the emergency room (ERER) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PEWS) has been used to identify signs of critical illness in pediatric patients.Objective To validate the PEWS system for assessing signs of critical illness in pediatric patients at Dr. Mohammad Hoesin Hospital, Palembang.Methods Subjects were children aged 1 month to 18 years who received treatment in the ERER and Pediatrics Ward inDr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PEWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the ER , then after 6 hours in the ward. We obtained the cut-off point, sensitivity, and specificity of PEWS, in terms of need for pediatric intensive care unit (PICU) treatment.Results One hundred fifty patients were included in this study. Patients with PEW score of 5 or greater in the ER were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cut-off point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P&lt;0.001).Conclusion A PEWS score of cut-off ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry.

Exact data on prognosis of children receiving invasive mechanical ventilation (IMV) after allogeneic hematopoietic SCT (HSCT) is lacking. We therefore started a prospective registry in four European university HSCT centers (Leiden, Paris, Prague and Utrecht) and their pediatric intensive care units (PICUs). The registry started in January 2009. In January 2013, the four centers together had treated a total of 83 admissions with IMV. The case fatality rate in these patients was 52%. Mortality 6 months after PICU discharge was 45%. There were significant differences between centers in the proportion of children who received IMV after HSCT (6-23%, P<0.01), in severity of disease on admission to PICU (predicted mortality 14-37%, P<0.01), in applying noninvasive ventilation before IMV (3-75% of admissions, P<0.01) and in the use of renal replacement therapy (RRT) (8-58% of admissions, P<0.01). Severe impairment in oxygenation, use of RRT and CMV viremia were independent predictors of mortality. Our study shows that mortality in children receiving IMV after HSCT remains high, but has clearly improved compared with older studies. Patient selection and treatment in PICU differed significantly between centers, which underscores the need to standardize and optimize the PICU admission criteria, ventilatory strategies and therapies applied in PICU.

1410 Postoperative Treatment in Picu. A 5-Year Experience

Aim: The objective of this study is to evaluate incidence, indications, length of stay and outcome of pediatric patients admitted postoperatively in a Pediatric Intensive Care Unit (PICU). Methods: Chart of 140 patients admitted to our PICU after different surgical procedures from January 2005 to December 2009, were reviewed retrospectively. Results: Age of patients ranged from 35 days to 14 years (mean age : 11,38 years) Types of surgical procedures demanding postoperative treatment in PICU are showed in table. Indications for PICU admission were : postoperative intensive treatment (88 patients), respiratory complications (31 patients), sepsis (11 patients) and low conscious level (10 patients). The incidence was 23,41% of total admissions. Mortality rate was 7,85% (mainly after major intracranial surgery). Mean duration of treatment was 7,82 days. Conclusions: Progress in intensive care improved outcome after major and complicated surgical procedures in pediatric population. In this study the main causes of admission in PICU postoperatively were major intracranial surgery (42,14%) and respiratory complications (22,14%).

Course and Predictors of Posttraumatic Stress Disorder in Parents after Pediatric Intensive Care Treatment of their Child

To study posttraumatic stress disorder (PTSD) in parents after unexpected pediatric intensive care unit (PICU) treatment of their child and to identify risk factors for its development. Parents completed PTSD questionnaires 3 and 9 months (N = 190) after PICU treatment. Risk factors included pretrauma data, medical data, social demographics and posttraumatic stress responses at 3 months. In total, 30.3% of parents met criteria for subclinical PTSD and 12.6% for clinical PTSD at 3 months. Clinical PTSD prevalence rates did not change over time. At 9 months, 10.5% of parents still met criteria for PTSD. Number of earlier stressful life events, earlier psychosocial care and posttraumatic stress responses at 3 months predicted persistent subclinical and clinical PTSD. PICU admission is a stressful event associated with persistent parental PTSD. Assessment of risk factors can facilitate detection of persistent PTSD for early intervention.

A pilot study on peritraumatic dissociation and coping styles as risk factors for posttraumatic stress, anxiety and depression in parents after their child's unexpected admission to a Pediatric Intensive Care Unit

AimTo study the prevalence of posttraumatic stress disorder (PTSD), anxiety and depression in parents three months after pediatric intensive care treatment of their child and examine if peritraumatic dissocation and coping styles are related to these mental health problems.MethodsThis is a prospective cohort study and included parents of children unexpectedly admitted to the Pediatric Intensive Care Unit (PICU) from January 2006 to March 2007. At three months follow-up parents completed PTSD (n = 115), anxiety and depression (n = 128) questionnaires. Immediately after discharge, parents completed peritraumatic dissocation and coping questionnaires. Linear regression models with generalized estimating equations examined risk factors for mental health problems.ResultsOver 10% of the parents were likely to meet criteria for PTSD and almost one quarter for subclinical PTSD. Respectively 15% to 23% of the parents reported clinically significant levels of depression and anxiety. Peritraumatic dissocation was most strongly associated with PTSD, anxiety as well as depression. Avoidance coping was primarily associated with PTSD.ConclusionA significant number of parents have mental health problems three months after unexpected PICU treatment of their child. Improving detection and raise awareness of mental health problems is important to minimize the negative effect of these problems on parents' well-being.