The Post-Intensive Care Syndrome in Children

Abstract

Improvements in devices and techniques used to provide life support for patients at intensive care units have reduced patient mortality. Increases in the number of survivors from a critical illness have brought long-term complications experienced during the post-intensive care period into question. The term postintensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years. Opioid and sedation exposure, the severity of illnesses and injuries, dense life support interventions, length of stay in the intensive care unit, and social isolation constitute risk factors for PICS in children. These factors cause the child to experience deterioration in physical, cognitive, and psychological health domains. Such deteriorations occur on various levels and have negative effects on quality of life. The purpose of this article is to raise awareness and help pediatric nurses to develop an understanding of the condition. Increasing awareness by pediatric nurses about the magnitude and effects of complications after discharge from the intensive care unit will be the first step to protect survivors from new problems, to provide assistance for ongoing problems, and to develop follow-up strategies. PICS-related morbidities affect the majority of children discharged from PICUs. We need to understand the scope of those morbidities and develop efficient nursing interventions accordingly. It is time to expand our goal for critical and noncritical care from life-saving into improvement of functional health status and quality of life.

Health-related quality of life of children and their parents 2 years after critical illness: pre-planned follow-up of the PEPaNIC international, randomized, controlled trial

“…At 2-year follow-up, only a few psychosocial domains in mainly older children remained impaired, whereas problems in other psychosocial multiitem domains, i.e., temperament and moods, getting along, and self-esteem, and single utility HUI scores emotions and cognition had normalized as compared with healthy control children. This is in line with a recent review that found that parent-reported HRQoL of children improved over time after critical illness [20]. Apparently, after PICU admission, the physical domain remained most impaired on the longer term.…”

“…Two years after PICU stay, children showed most impairments in physical HRQoL domains and therefore, follow-up programs should focus on these physical problems after PICU admission [20]. In addition, psychologists should screen on developmental problems in younger children and mental health problems in schoolaged children.…”

“…These classifications were performed to capture ethnical and regional differences in the frequency of consanguinity general health 5 and 10 years after critical illness [21]. This implicates that these problems remain during the development of the child and might interfere with daily life as they may lead to functional disabilities [9,20]. It might be hypothesized that the timing of the follow-up after PICU admission is best within a couple of months to screen for growth and development impairments in younger children and to prevent mental health problems in older children [8].…”

Physical Functioning After Admission to the PICU: A Scoping Review

“…As surviving critical illness can have long-term effects on both PICU survivors and parents, who play a key role in helping to recover, follow-up care for parents is necessary to be able to adequately support the patient and parents. Early mobility exercises, the practice of physical therapy during critical illness, and family engagement/empowerment are promising intervention strategies ( 91 , 92 ).…”

What's in this issue?

“…This is hugely problematic as survival from PIC admission is high (at around 96%) 17 compared with that of adult ICU. In addition, as these are children (most young children <2 years of age) with a whole life ahead of them, a lack of follow up (to identify problems early and instigate support) may lead to life long problems (psychological, social, cognitive, and physical) for both the child and their family 18 . Three years on from this survey, it would be useful to re‐examine this and determine if any progress has been made.…”