Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 4, 2017; 6(2): 124-134
Published online May 4, 2017. doi: 10.5492/wjccm.v6.i2.124
Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review
Elizabeth A Herrup, Beth Wieczorek, Sapna R Kudchadkar
Elizabeth A Herrup, Beth Wieczorek, Departments of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Sapna R Kudchadkar, Departments of Anesthesia and Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: All authors contributed equally in developing study concept and design, data collection and organization, and manuscript writing and editing.
Conflict-of-interest statement: No author declares a conflict-of-interest.
Data sharing statement: The technical appendix is available from the corresponding author at eherrup1@jhmi.edu. No statistical code or dataset is available as the study did not involve any biostatistics.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elizabeth A Herrup, MD, Departments of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, United States. eherrup1@jhmi.edu
Telephone: +1-410-9552393 Fax:+1-410-5025132
Received: October 29, 2016
Peer-review started: November 2, 2016
First decision: February 17, 2017
Revised: February 25, 2017
Accepted: March 23, 2017
Article in press: March 25, 2017
Published online: May 4, 2017
Processing time: 185 Days and 7.7 Hours
Abstract
AIM

To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome (PICS) in adults, including physical, neurocognitive and psychological morbidities.

METHODS

A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit (PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis.

RESULTS

Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine and narcotic administration.

CONCLUSION

PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Keywords: Pediatric intensive care; Pediatric intensive care unit; Critical illness; Postintensive care syndrome; Post-traumatic stress; Trauma; Patient outcomes

Core tip: The majority of critically ill children admitted to pediatric intensive care units (PICUs) survive their illness. Therefore, it is critical to address the impact and extent of new or worsening morbidities that these children experience as a consequence of critical illness. Postintensive care syndrome is a well-described phenomenon in adult ICU patients, defining common types of morbidity that can occur after hospitalization. This review provides a synthesis of the available literature describing physical, neurocognitive and psychological morbidities that develop in the pediatric critical care population.