Post-Intensive-Care Syndrome for the Pediatric Neurologist

Abstract

The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.

Keywords: Critical Care; Educational intervention; PICS; Pediatrics; Post-intensive-care syndrome.

Figure 1.

Post-intensive Care Syndrome in pediatrics (PICS-p) framework. The patient and all members of the family are exposed to the patient’s illness and the PICU environment. Upon discharge, all members of the family contribute to the recovering child’s cognitive, emotional, physical and social health status, and each family member requires individual consideration. The child’s condition may improve, decline, or remain static over time. From: Manning, JC et al. Pediatric Critical Care Medicine 2018; 19:298–300. Reprinted with permission.