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Conceptualizing Post Intensive Care Syndrome in Children—The PICS-p Framework*

Manning, Joseph C. RN, PhD1,2,3; Pinto, Neethi P. MD, MS4; Rennick, Janet E. RN, PhD5,6; Colville, Gillian MPhil, CPsychol7; Curley, Martha A. Q. RN, PhD8,9,10

Pediatric Critical Care Medicine: April 2018 - Volume 19 - Issue 4 - p 298-300
doi: 10.1097/PCC.0000000000001476
Feature Review Article

Context: Over the past several decades, advances in pediatric critical care have saved many lives. As such, contemporary care has broadened its focus to also include minimizing morbidity. Post Intensive Care Syndrome, also known as “PICS,” is a group of cognitive, physical, and mental health impairments that commonly occur in patients after ICU discharge. Post Intensive Care Syndrome has been well-conceptualized in the adult population but not in children.

Objective: To develop a conceptual framework describing Post Intensive Care Syndrome in pediatrics that includes aspects of the experience that are unique to children and their families.

Data Synthesis: The Post Intensive Care Syndrome in pediatrics (PICS-p) framework highlights the importance of baseline status, organ system maturation, psychosocial development, the interdependence of family, and trajectories of health recovery that can potentially impact a child’s life for decades.

Conclusion: Post Intensive Care Syndrome in pediatrics will help illuminate the phenomena of surviving childhood critical illness and guide outcomes measurement in the field. Empirical studies are now required to validate and refine this framework, and to subsequently develop a set of core outcomes for this population. With explication of Post Intensive Care Syndrome in pediatrics, the discipline of pediatric critical care will then be in a stronger position to map out recovery after pediatric critical illness and to evaluate interventions designed to mitigate risk for poor outcomes with the goal of optimizing child and family health.

1Children’s and Families Research, Centre for Innovative Research across a Life Course, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.

2Division of Family Health, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.

3Division of Nursing, School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, United Kingdom.

4Section of Pediatric Critical Care, Department of Pediatrics, The University of Chicago, Chicago, IL.

5Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada.

6Division of Critical Care, Ingram School of Nursing, Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada.

7Paediatric Psychology Service, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom.

8Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

9Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

10Critical Care and Cardiovascular Program, Boston Children’s Hospital, Boston, MA.

*See also p. 375.

Dr. Rennick disclosed that she holds a Senior Clinical Research Scholar Award from the Fonds de Recherche du Québec—Santé, which provides salary support for her research program. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies