Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

Abstract

Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the "post-intensive care syndrome in pediatrics" (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.

Keywords: long-term outcomes; outcomes; pediatric critical illness; pediatric intensive care; post-intensive care syndrome.

Figure 1

Number of manuscripts evaluating post-discharge outcomes after pediatric critical illness and study designs. Composite in the legend refers to the additive total number of articles. Original figure by Maddux et al. [20]. Graph generated using a comprehensive search strategy outlined in Table S2 of the Supplemental Digital Content in the original article, title and abstract exclusion, and dual full-text screening of the remaining articles [20]. Reprinted with appropriate permission from Wolters Kluwer. Original Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Figure 2

A framework for the post-intensive care syndrome—pediatrics (PICS-p). Original figure by Manning et al. [23]. Reprinted with appropriate permission from Wolters Kluwer. Original Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.