Chronic Illness in Pediatric Critical Care

Abstract

Children and Youth with Special Healthcare Needs (CYSHCN), children with medical complexity (CMC), and children with chronic, critical illness (CCI) represent pediatric populations with varying degrees of medical dependance and vulnerability. These populations are heterogeneous in underlying conditions, congenital and acquired, as well as intensity of baseline medical needs. In times of intercurrent illness or perioperative management, these patients often require acute care services in the pediatric intensive care (PICU) setting. This review describes epidemiologic trends in chronic illness in the PICU setting, differentiates these populations from those without significant baseline medical requirements, reviews models of care designed to address the intersection of acute and chronic illness, and posits considerations for future roles of PICU providers to optimize the care and outcomes of these children and their families.

Prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic

“…According to many studies, within hospitals, and specifically PICUs, children with chronic illnesses represent an increasing proportion of the population and an important financial burden of healthcare utilization. 3 , 5 , 19 The increasing trend of occupation of PICU beds and ventilator days by critically ill children may be related to the increasing trend or hospitalization of chronic care patients. 20 Table 3 shows the use of clinical resources, including respiratory support, venous line, and other devices.…”

“… 2 , 3 Due to advances in intensive care, there has been a reduction in mortality, but at the expense of immobility, longer mechanical ventilation, and increased use of hospital resources. 4 , 5 , 6 The use of drugs such as corticosteroids, neuromuscular blockers, and sedatives increased the risk of physical and neurocognitive sequelae. 7 These children may develop muscle weakness and delirium as well as decreased functionality and difficulties in activities of daily living, school performance, and social interaction.…”

Slow and Steady: Optimizing Intensive Care Unit Treatment Weans for Children with Chronic Critical Illness

“…There is no uniform definition for PCCI; existing definitions have included variable lengths of stay, numbers of annual admissions, corrected gestational ages, medical technologies used, and multiorgan involvement. 1 3 4 7 12 16 17 For this study, we defined eligible patients as those of 0 to 18 years of age who (1) were admitted to the NICU for >30 days and corrected to ≥34 weeks gestational age OR were admitted to PICU or CICU >21 days; AND (2) used one or more technology to sustain vital functions. A sample size of 300 patients was calculated to have 80% power to detect a reduction in clinical setbacks of one per hospitalization and a reduction of length of stay by 3 days.…”

“…1 In acute-care hospitals in the United States, infants and children with PCCI are estimated to occupy 40% of general pediatric inpatient beds, 25 to 48% of pediatric intensive care unit (PICU) and cardiac intensive care unit (CICU) beds, and 34% neonatal intensive care unit (NICU) beds. 2 3 4 5 6 7 Patients with PCCI are not just admitted to the intensive care units (ICUs) of the United States but ICUs around the world. 8 9 10 These ICU admissions are often triggered by an acute event, such as the birth of an extremely premature newborn who later develops PCCI or respiratory decompensation in a child with preexisting PCCI.…”

“…In this way, frequent treatment titrations may prolong ICU stays for these patients. 4 11 12 Treatment titrations within the last week of ICU discharges have also been shown to be associated with readmission. 13 Qualitatively, clinicians and families report that a “slow and steady” approach to ICU care, with more gradual treatment titrations and more consistent clinical management, results in fewer setbacks and shorter hospitalizations for children with PCCI.…”