Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Hillman Scholars Program in Nursing Innovation at the University of Pennsylvania School of Nursing, Philadelphia, PA.
Pediatr Crit Care Med. 2018 Mar;19(3):e164-e171. doi: 10.1097/PCC.0000000000001430.
To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.
For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.
Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.
Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.
Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these-four case-control and three prospective cohort studies-reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.
Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
确定神经典型儿童在危重病后通过神经心理测试评估认知障碍的相关风险因素。
为了进行这项系统综述，我们在 1960 年 1 月至 2017 年 3 月期间检索了 Cochrane 图书馆、Scopus、PubMed、Ovid、Embase 和 CINAHL 数据库。
纳入的研究对象为在 PICU 随访评估时年龄为 3-18 岁，且使用客观标准化神经心理测试的患者，该测试至少有一个认知功能维度。排除的研究对象为有心脏骤停、创伤性脑损伤或与神经认知障碍相关的遗传异常病史的患者。
有 12 项研究符合抽样标准，并使用纽卡斯尔-渥太华质量评估量表进行了评分。
与健康对照组或正态人群数据相比，有 10 项研究报告了至少一个认知域的评分显著降低；其中 7 项研究为病例对照研究，3 项研究为前瞻性队列研究，报告了在一个以上认知域的评分显著降低。与危重病后认知障碍相关的风险因素包括危重病时年龄较小、/或随访时年龄较大、社会经济地位较低、高氧需求、以及使用机械通气、镇静和止痛药物。
确定危重病后认知结果不良的风险因素可能有助于医疗团队调整患者的风险，/或提供随访服务，以改善高危儿童的长期认知结果。
