Post-Intensive Care Syndrome for the Pediatric Neurologist

Abstract In recent years, the number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-Intensive Care morbidity. Critical illness in childhood can affect a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the Intensive Care Unit and continue after the patient and family return home has recently been termed Post-Intensive Care Syndrome (PICS). A conceptual model of the PICS experienced by children who survive critical illness, their siblings, and parents has been coined PICS-p. Due to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurologic injury are among those at highest risk for PICS-p. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization, and remains involved after the patient leaves the hospital. For that reason, it is important for pediatric neurologists to become versed in the early recognition and management of PICS-p. In this review, we discuss the current knowledge regarding PICS-p and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of PICS-p, which have been successfully implemented at our institutions. Dissemination of this ‘road map' may assist others interested in establishing recovery programs, therefore mitigating the burden of post-Intensive Care morbidity in children.