Cuevas-Asturias Sofia, Rafferty Claire, Mitchell Hannah, Tremlett William, Ramnarayan Padmanabhan, Pattison Natalie
Department of Surgery & Cancer, Imperial College London, London, United Kingdom.
Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.
PLoS One. 2025 Feb 6;20(2):e0318312. doi: 10.1371/journal.pone.0318312. eCollection 2025.
Paediatric Critical Care (PCC) supports the recovery of children with severe illness. In the UK, there are 30 PCC units with a total of approximately 400 beds. There is constant demand for these beds with a mean five-day length of stay and admissions increasing at a greater rate than age-specific population growth. Prolonged stay patients account for approximately half of all PCC patient bed days. Children with complex critical illness (CCI) need input from multiple different teams alongside support for their family. CCI often become prolonged PCC-stay patients too. Internationally, there is variation in the definition of CCI, this creates service variation and tensions around what resources can be provided including discharge planning, provision, and support. Objective: The face of Paediatric Critical Care, in the UK and internationally has changed over the last ten years with a growing cohort of complex critically ill patients. This systematic review aims to look at current nomenclature, criteria, and outcome measures of priority in this undefined patient population.
Inclusion criteria: All types of studies examining children with complex critical illness (age <18 years) admitted to any paediatric critical care. The review is registered on Prospero. Medline, Embase, Maternity and Infant care, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Trip database will be searched from 2014 to May 2024. The search was limited to ten years as children with complex critical illness are a relatively new concept within PCC. Therefore, the timeline was limited to increase the accuracy and applicability of the review. Search limits included all languages, excluded the setting of neonatal intensive care, and age>18 years old. The final search strategy was developed in Medline and peer-reviewed by a health research librarian not involved in the study. This was translated to other databases as appropriate. Four independent reviewers will screen citations for eligible studies and perform data extraction.
A systematic review methodology has been used to develop a broad understanding of the literature which will be used to develop further work in this area. Using a rigorous and stepwise approach, the whole spectrum of scientific publications on children with complex critical illness in paediatric intensive care will be reviewed, ensuring this study is as comprehensive as possible. This includes quantitative, qualitative, theoretical, and grey literature. A limitation of this systematic review is the use of many terms to describe children with complex critical illness in the literature resulting in a high number of publications on this topic.
儿科重症监护（PCC）有助于重症患儿的康复。在英国，有30个PCC病房，共计约400张床位。这些床位的需求持续存在，平均住院时间为5天，入院人数的增长速度超过了特定年龄段人口的增长速度。长期住院患者约占所有PCC患者住院天数的一半。患有复杂危重病（CCI）的儿童除了需要家人的支持外，还需要多个不同团队的投入。CCI患儿往往也会成为长期住院的PCC患者。在国际上，CCI的定义存在差异，这导致了服务差异以及在包括出院计划、提供和支持等可提供的资源方面的紧张关系。目的：在过去十年中，英国乃至国际上儿科重症监护的面貌已经发生了变化，复杂危重病患者的队列不断增加。本系统评价旨在研究这一未明确界定的患者群体当前的命名法、标准和优先结局指标。
纳入标准：所有研究入住任何儿科重症监护病房的复杂危重病患儿（年龄<18岁）的各类研究。该评价已在国际系统评价注册库（Prospero）登记。将检索2014年至2024年5月期间的医学数据库（Medline）、荷兰医学文摘数据库（Embase）、母婴护理数据库、考克兰图书馆、护理学与健康照护领域累积索引数据库（CINAHL）以及循证医学高级数据库（Trip）。检索范围限于十年，因为复杂危重病患儿在PCC中是一个相对较新的概念。因此，限制时间范围以提高评价的准确性和适用性。检索限制包括所有语言，排除新生儿重症监护环境以及年龄>18岁的情况。最终检索策略在Medline中制定，并由未参与该研究的健康研究图书馆员进行同行评审。并酌情将其翻译至其他数据库。四位独立评审员将筛选符合条件的研究的引文并进行数据提取。
本研究采用系统评价方法，以全面了解相关文献，为该领域的进一步研究提供依据。通过严谨且循序渐进的方法，将对儿科重症监护中有关复杂危重病患儿的各类科学出版物进行全面综述，确保本研究尽可能全面。这包括定量研究、定性研究、理论研究和灰色文献。本系统评价的一个局限性是，文献中使用了许多术语来描述复杂危重病患儿，导致关于该主题的出版物数量众多。
