Transition From Paediatric Intensive Care to General Paediatrics and Pneumology Units : a Study of the Post-intensive Care Syndrome

Several large databases report mortality rates around 4% in pediatric intensive care units (PICUs) in developed countries, indicating that most children admitted to these units survive. Some pediatric survivors experience long-term morbidity associated with their PICU care, but comprehensive descriptive data are lacking.

In 2010, the Society of Critical Care Medicine (USA) organized a working group to raise awareness of long-term cognitive, psychological and physical impairments in adult ICU survivors. Impairments in these three domains are collectively referred to as Post-Intensive Care Syndrome ""PICS"". In the adult population, PICS affects 50-70% of ICU survivors, and its effects may persist for 5-15 years after ICU hospitalization. In adults, recovery and quality of life after ICU stay has been described by the World Health Organization.

In pediatrics, the framework of the pediatric post-intensive care syndrome ""PICS-p"" was developed in 2018. In addition to the elements corresponding to the three conventional domains of physical, cognitive and emotional health constituting the adult PICS, the PICS-p include a domain of ""social health"" of children and their families. This latter aspect is justified by the fact that serious illness affects the social functioning of children and their families; that is, reintegration with friends at school, their social capital and the impact on the work of parents caring for a sick child. These social health problems, intertwined with morbidity in other health domains, can have a further negative impact on the quality of child development and survival. A variety of recovery trajectories for surviving children and their families have been described in the PICS - p framework: improvement, deterioration, vacillation or plateau in the days or decades following PICU discharge. The available data, although still limited, suggest that the situations of children and parents with respect to PICS are more heterogeneous than those of adult post-resuscitation survivors. A 2017 review described the physical, neurocognitive and psychological outcomes in several cohorts of children who survived critical illness in intensive care, with most cohorts investigating a single health domain (physical or neurocognitive or psychological morbidity). In the same review, the authors found that outcomes were more common in younger children, from families with low socioeconomic status, with more invasive procedures or interventions, with high doses of benzodiazepines and narcotics, and varied by disease type.

A wide range of psychological complications have also been described in families. While research on siblings is limited, one review reported prevalence of acute stress, post-traumatic stress symptoms, anxiety and significant depression in parents after their child's discharge from intensive care (between 10 and 84% varying between studies and symptoms). Psychological symptoms persist for several months. Risk factors for long-term problems include unexpected admission to the ICU and the number of medical interventions performed there, limited social support and negative memories of the ICU stay. It should be noted that post-traumatic symptoms in children are associated with parental symptoms.

Today, in the majority of hospitals, there is no specific procedure for the prevention or management of PICS-p. In a recent editorial, pediatricians questioned the role of everyone in promoting a full recovery of children after intensive care: intensive care professionals, families, pediatricians in downstream services, professionals in rehabilitation, psychology or psychiatry, or ambulatory medicine; without giving a single answer.