Herrup Elizabeth A, Wieczorek Beth, Kudchadkar Sapna R
Elizabeth A Herrup, Beth Wieczorek, Departments of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, United States.
World J Crit Care Med. 2017 May 4;6(2):124-134. doi: 10.5492/wjccm.v6.i2.124.
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.
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.
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.
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.
综合现有证据，聚焦于危重症儿科幸存者中属于成人重症监护后综合征（PICS）既定范畴内的疾病，包括身体、神经认知和心理方面的疾病。
在MEDLINE、EMBASE、Cochrane图书馆、PsycINFO和CINAHL中进行全面检索，使用控制词汇和关键词来识别报告儿科重症监护病房（PICU）患者PICS特征的研究。两名评审员独立筛选所有标题和摘要并进行数据提取。在检索出的3176篇文章中，确定了252篇摘要进行全文审查，19篇被确定纳入该综述。所有报告PICU患者PICS特征的研究都纳入了最终的综合分析。
确定了19项在1995年至2016年间发表的符合纳入标准的研究，并将其分为报告身体、神经认知和心理这三类疾病中每一类的研究。大多数纳入文章报告的是前瞻性队列研究，所使用的结局指标存在显著差异。研究综合表明，在危重症幸存者儿童中，涵盖PICS的疾病有详细描述，且通常会随时间缓解。这些疾病发生的危险因素包括年龄较小、社会经济地位较低、侵入性操作或干预的次数增加、疾病类型以及苯二氮䓬类药物和麻醉剂使用增加。
与PICS相关的疾病影响了相当比例从PICU出院的儿童。为了进一步明确儿童中的PICS，需要使用标准化工具进行更多研究，以更好地了解出院后疾病的范围和自然史。对于设计改善PICU患者长期结局的干预措施而言，提高我们对儿科人群危重症后身体、神经认知和心理疾病的认识至关重要。
