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

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 intensive care unit discharge. PICS has been well-conceptualized in the adult population but not in children.Objective: To develop a conceptual framework describing Post-Intensive CareSyndrome in pediatrics (PICS-p) that includes aspects of the experience that areunique to children and their families.Data Synthesis: The 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: PICS-p 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 PICS-p, 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