Describing Post-Intensive Care Syndrome in Pediatric Critical Care Survivors

Post-intensive Care Syndrome (PICS) represents a broad range of morbidities that impact around half of adult ICU survivors. The incidence, risk factors and associated quality of life of PICS have yet to be well described in children. Applying PICS to children is difficult since it is challenging to assess a child’s pre-illness baseline. Children often cannot properly self report symptoms and parental perception on the severity of illness and its impact on health varies. The aim of this study was to compare quality of life (QOL) and the cognitive, physical, and psychiatric function of PICU survivors at baseline to their health status in PICS domains at one and three months after ICU discharge. In an 8-month single center, prospective study of 5-17 year olds admitted to the PICU or Cardiac ICU ≥ 48 hours, the primary outcome was incidence of PICS at one and three months after ICU discharge. Secondary outcomes included the association of PICS with clinical factors and with a change in QOL. Outcomes were measured using 5 parent proxy PROMIS forms (mobility, fatigue, cognitive function, depression, and anxiety) and with Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scores. QOL was measured using a brief parent proxy PedsQL scale. Health status by these measures was assessed at pre-ICU admission baseline and at one and three months post-ICU discharge. Evidence of PICS was defined as one standard deviation decline from baseline in at least one PROMIS domain. 57 of 136 eligible (42%) patients were enrolled. 20 of 48 survivors (42%) evaluated at one month met criteria for PICS. At three months, 8 of 17 patients (47%) had persistence of PICS while 9 patients (53%) had recovery within less than one standard deviation to their pre-illness baseline. Neurologic dysfunction was the leading diagnosis in children with PICS at one month (7/20) compared to respiratory failure in those without PICS (17/28). Children with PICS were more often mechanically ventilated (65% vs 36%; p=0.045) and had more frequent exposure to benzodiazepines, opioids, pressors, and neuromuscular blockade (p=0.01-0.04). Those with PICS had greater decline below their baseline QOL at 1 month (-17.3 vs. -0.3; p<0.01). Yet, those without PICS had baseline worse POPC, PCPC and QOL scores when compared to those with PICS (p=0.001; p=0.001; p=0.0007). This sample of school age ICU survivors represents the first reported incidence of PICS in pediatrics and is similar to adult data. Children with PICS suffered a decline in quality of life at one month after ICU discharge. Children with higher baseline functional status were more likely to have PICS yet were also more likely to be exposed to mechanical ventilation and continuous sedative infusions. These findings highlight the importance of addressing the long-term health outcomes of pediatric survivors of critical illness in clinical care and future research.