Poor Functional Outcomes in Pediatric Intensive Care Survivors in Brazil: Prevalence and Associated Factors

Area of Science:

• Pediatric critical care medicine
• Functional outcomes research
• Public health in developing nations

Background:

• Survivors of pediatric critical illnesses frequently develop functional impairments, impacting long-term quality of life.
• Existing data on functional outcomes in pediatric critical illness survivors is predominantly from high-income countries, leaving a gap in understanding for diverse populations.
• There is a critical need to assess functional status changes in Brazilian children and adolescents following critical illness to inform targeted interventions.

Purpose of the Study:

• To evaluate functional status changes in children and adolescents who survive critical illnesses in Brazil.
• To identify factors associated with functional impairments at pediatric intensive care unit (PICU) discharge among Brazilian pediatric survivors.
• To provide crucial data on functional recovery in a resource-limited setting.

Main Methods:

• A cross-sectional study was conducted involving 303 pediatric patients discharged from a tertiary PICU.
• The Functional Status Scale (FSS) was administered by two blinded researchers to assess six functional domains: mental status, sensory, communication, motor, feeding, and respiratory.
• Functional decline was defined as an increase in FSS total scores at discharge compared to baseline.

Main Results:

• A significant prevalence of functional decrease (68%) was observed at PICU discharge among the study participants.
• Younger age (less than 12 months) was associated with a 1.44-fold increased chance of poor functional outcomes.
• Longer duration of mechanical ventilation (≥11 days) independently increased the likelihood of poor functional results by 1.74 times.

Conclusions:

• This study is the first in Brazil to demonstrate that young age (≤12 months) and prolonged invasive mechanical ventilation are independent risk factors for functional impairment in pediatric critical illness survivors.
• The findings highlight the vulnerability of young children and those requiring extended mechanical support, emphasizing the need for specialized post-PICU care pathways.
• Understanding these specific risk factors is crucial for developing targeted rehabilitation strategies and improving long-term functional recovery for pediatric survivors in Brazil.