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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
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Promoting Functional Recovery in Critically Ill Children.

Amit Sinha1, Sarah Rubin2, Jessica M Jarvis1

  • 1Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.

Pediatric Clinics of North America
|April 30, 2023
PubMed
Summary

Most pediatric critical illness survivors face long-term functional impairments, known as post-intensive care syndrome in pediatrics (PICS-p). Addressing PICS-p requires early rehabilitation, caregiver support, and screening, while tackling social determinants of health is a key future direction.

Keywords:
Pediatric intensive care unit (PICU)Post-ICU morbidityPost–intensive care syndrome in pediatrics (PICS-p)RecoveryRehabilitation

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Area of Science:

  • Pediatric critical care medicine
  • Neuroscience
  • Rehabilitation medicine

Background:

  • Over two-thirds of pediatric critical illness survivors experience persistent functional impairments after discharge, termed post-intensive care syndrome in pediatrics (PICS-p).
  • Risk factors for PICS-p encompass child and family characteristics, invasive procedures, and social determinants of health.
  • PICS-p significantly impacts long-term quality of life and functional independence in pediatric populations.

Purpose of the Study:

  • To review current understanding and approaches to managing post-intensive care syndrome in pediatrics (PICS-p).
  • To identify key risk factors, remediation strategies, and challenges associated with PICS-p.
  • To outline future research directions for improving PICS-p outcomes.

Main Methods:

  • Literature review of pediatric critical care studies focusing on PICS-p.
  • Synthesis of data on risk factors, including social determinants of health.
  • Analysis of current and proposed remediation strategies and screening approaches.

Main Results:

  • Established risk factors for PICS-p include child/family traits, invasive procedures, and social determinants of health.
  • Effective remediation strategies involve early rehabilitation, reduced sedation, caregiver psychosocial support, family-centered care, and longitudinal PICS-p screening.
  • Significant challenges remain in developing feasible screening tools and coordinating multidisciplinary care.

Conclusions:

  • Post-intensive care syndrome in pediatrics is a prevalent and complex condition requiring multifaceted interventions.
  • Future efforts must prioritize addressing social determinants of health and rigorously evaluating treatment efficacy and equity.
  • Improved screening methods and coordinated multidisciplinary care are essential for optimizing outcomes for pediatric critical illness survivors.