PP558 [Post PICU » Post intensive care syndrome (PICS)]: A NEW STATISTICAL METHODOLOGY TO INVESTIGATE POST INTENSIVE CARE SYNDROME IN PEDIATRIC SURVIVORS AND THEIR FAMILIES

Rahmaty, Zahra; Manning, Joseph C; Pérez, M Pilar Tormos; Ramelet, Anne‐Sylvie

doi:10.1097/01.pcc.0000901800.95833.9f

Cited by 5 publications

(6 citation statements)

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“…This study adds to existing evidence that PICS-p is common, and its occurrence rate is variable depending on how it is defined (16). It also highlights that quantifying PICS-p, or indeed PICS-pediatric patients and families (PICS-pf), is challenging as this is a complex, heterogeneous and dynamic construct (17). Until the epidemiology is better understood and the use of appropriate, standardized screening tools agreed upon, we hesitate using functioning, HRQL or a composite of these outcomes in isolation to determine the occurrence rate of PICS-p as this is an oversimplification and does not capture the breadth of survivorship sequelae.…”

Section: Discussionmentioning

confidence: 99%

“…challenging as this is a complex, heterogeneous and construct (17). Until the epidemiology is better understood and the use of appropriate, standardized screening tools agreed upon, we hesitate using functioning, HRQL or a composite of these outcomes in isolation to determine the occurrence rate of PICS-p as this is an oversimplification and does not capture the breadth of survivorship sequelae.…”

Section: At the Bedsidementioning

confidence: 99%

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Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Choong,

Fraser,

Cameron

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To compare post-PICU discharge functioning, health-related quality of life (HRQL), and parental stress before and after the implementation of an early rehabilitation bundle. Design and Setting: Prospective cohort substudy within an early rehabilitation implementation program, conducted at the PICUs at McMaster Children’s Hospital and London Health Sciences, London, Ontario, Canada. Interventions: A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization. Patients with an anticipated 48-hour PICU length of stay were approached for consent to participate. Patients: Critically ill children with an anticipated 48-hour PICU length of stay were approached for consent to participate. Measurements and Main Results: Patient-/proxy-reported outcome measures were assessed at baseline, PICU discharge, and 1 and 3 months post-PICU discharge using: 1) Pediatric Evaluation of Disability Inventory Computer Adaptive Test to assess physical, social, cognitive, and responsibility/caregiver domains of functioning; 2) KIDSCREEN to assess HRQL; and 3) the Pediatric Inventory for Parents to assess caregiver stress. A total of 117 participants were enrolled. Patient demographic characteristics were similar in the pre- and post-intervention groups. Following bundle implementation, 30 of 47 respondents (63.8%) experienced functional decline and 18 of 45 (40%) experienced low HRQL at PICU discharge. Eighteen of 36 (50%) at 1 month and 14 of 38 (36.8%) at 3 months experienced either persistent functional decline and/or low HRQL; 2.8% and 2.6% at 1- and 3-month follow-up, respectively, experienced both persistent functional decline and low HRQL. There were no significant differences in the rates of persistent functional decline, low HRQL, or caregiver stress scores post-bundle compared with pre-rehabilitation bundle implementation. Conclusions: We were unable to adequately determine the efficacy of a rehabilitation bundle on patient-centered outcomes as this substudy was not powered for these outcomes. Our results did reveal that persistent low functioning is common in PICU survivors, more common than low HRQL, while experiencing both functional decline and low HRQL was uncommon.

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Section: Discussionmentioning

confidence: 99%

Section: At the Bedsidementioning

confidence: 99%

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Choong,

Fraser,

Cameron

et al. 2024

Pediatric Critical Care Medicine

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“…Due to the retrospective character of this study, the functional outcome assessment was limited to the PCPC as a simple and common measure of PICU outcomes. Prospective investigations should also assess cognitive, emotional, and social health functioning, as their impairment contributes to post-PICU sequelae, such as the post-intensive care syndrome (Manning et al, 2018;Perry-Eaddy et al, 2023;Rahmaty et al, 2023).…”

Section: Discussionmentioning

confidence: 99%

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Paul,

Greve,

Hegemann

et al. 2024

Front. Neurosci.

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Background and objectivesAmplitude-integrated EEG (aEEG) is used to assess electrocortical activity in pediatric intensive care if (continuous) full channel EEG is unavailable but evidence regarding the meaning of suppressed aEEG amplitudes in children remains limited. This retrospective cohort study investigated the association of suppressed aEEG amplitudes in critically ill children with death or decline of neurological functioning at hospital discharge.MethodsTwo hundred and thirty-five EEGs derived from individual patients <18 years in the pediatric intensive care unit at the University Hospital Essen (Germany) between 04/2014 and 07/2021, were converted into aEEGs and amplitudes analyzed with respect to age-specific percentiles. Crude and adjusted odds ratios (OR) for death, and functional decline at hospital discharge in patients with bilateral suppression of the upper or lower amplitude below the 10th percentile were calculated. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were assessed.ResultsThe median time from neurological insult to EEG recording was 2 days. PICU admission occurred due to neurological reasons in 43% and patients had high overall disease severity. Thirty-three (14%) patients died and 68 (29%) had a functional decline. Amplitude suppression was observed in 48% (upper amplitude) and 57% (lower amplitude), with unilateral suppression less frequent than bilateral suppression. Multivariable regression analyses yielded crude ORs between 4.61 and 14.29 and adjusted ORs between 2.55 and 8.87 for death and functional decline if upper or lower amplitudes were bilaterally suppressed. NPVs for bilaterally non-suppressed amplitudes were above 95% for death and above 83% for pediatric cerebral performance category Scale (PCPC) decline, whereas PPVs ranged between 22 and 32% for death and 49–52% for PCPC decline.DiscussionThis study found a high prevalence of suppressed aEEG amplitudes in critically ill children. Bilaterally normal amplitudes predicted good outcomes, whereas bilateral suppression was associated with increased odds for death and functional decline. aEEG assessment may serve as an element for risk stratification of PICU patients if conventional EEG is unavailable with excellent negative predictive abilities but requires additional information to identify patients at risk for poor outcomes.

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“…To study influential factors, the risks and protectors, systems around the child/family and the context they live in were considered 18. All potential influential factors will be collected 48 hours after PICU.…”

Section: Methodsmentioning

confidence: 99%

“…We aim to build our study on the existing work of Manning et al and Curley and Scott in the UK and the USA,16 17 as well as adding novel measurements and a conceptual framework that considers different systems, family, community and society resources around the child18 in investigating the influential factors. This will allow us to have Swiss PICU survivors’ data comparable to international data while providing new insights.…”

Section: Introductionmentioning

confidence: 99%

Post Intensive Care Syndrome in Swiss Paediatric survivors and their Families (PICSS-PF): a national, multicentre, longitudinal study protocol

Rahmaty,

Manning,

Perez

et al. 2023

BMJ Open

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IntroductionPaediatric intensive care units (PICUs) survivors and their families often experience widespread morbidity and psychosocial consequences after discharge, known as post-intensive care syndrome in paediatrics (PICS-p). In Switzerland, more than 5000 children are admitted to PICUs each year, and despite the high survival rate, there are no data on post-PICU recovery. This study aims to investigate PICS in children and families and identify its associated factors.Methods and analysisThis is a national, multicentre, longitudinal, observational study that includes PICU survivors, main family caregivers and siblings (n=1300) recruited from the eight Swiss accredited PICUs with follow-up at discharge, 1, 3 and 6 months after discharge from the PICU. Data will be collected on the domains of physical, emotional, social and cognitive health, as well as factors affecting the outcome related to demographics, clinical specification, PICU and family environment, as well as community and social resources. Structural equation models and growth mixture models will analyse the outcomes, and the heterogeneity of recovery that shed light on the diverse recovery experiences of children and their families. The study identifies risk and protective factors with a focus on the influence of social and familial resources. It will also explore the mutual impact of the child’s recovery and parent/sibling psychosocial health.Ethics and disseminationThe protocol is approved by the CER-VD ethics committee. Participants will be provided with verbal and written explanations of the study, and their privacy and anonymity will be protected throughout the process. The results will be presented at local and international conferences.Approval numberSwiss ethics committees ID: 2022-02128, representing the eight cantons for both French and German-speaking parts of Switzerland.

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PP558 [Post PICU » Post intensive care syndrome (PICS)]: A NEW STATISTICAL METHODOLOGY TO INVESTIGATE POST INTENSIVE CARE SYNDROME IN PEDIATRIC SURVIVORS AND THEIR FAMILIES

Abstract: antagonists and 12% IL-6 receptor blockers). Mortality rate was 0%. CONCLUSIONS:Although PIMS following exposure to Sars-Cov-2 is a clinical syndrome with severe presentation, prognosis is good with appropriate and early treatment.

Cited by 5 publications

References 0 publications

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Post-Intensive Care Sequelae in Pediatrics—Results of an Early Rehabilitation Implementation Study

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Post Intensive Care Syndrome in Swiss Paediatric survivors and their Families (PICSS-PF): a national, multicentre, longitudinal study protocol

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