Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Examining the impact of Buerger-Allen exercises on alleviating muscle cramps in extubated patients

Objective:This study aimed to evaluate the effectiveness of Buerger-Allen exercise(BAE)in reducing muscle cramps among recently extubated patients in the intensive care unit(ICU).Materials and Methods:A quantitative,quasi-experimental design was employed,involving 92 recently extubated ICU patients randomly assigned to either an experimental or control group.The experimental group underwent BAE,a three-step intervention targeting lower extremity circulation and muscle cramp reduction.The exercises included the elevation of lower extremities,foot and leg exercises,and a rest and recovery phase,administered twice daily for 10 days.The control group received standard nursing care without any specific exercise regimen.Muscle cramp severity was assessed using the modified Penn Spasm Frequency Scale before and after the intervention.Results:The experimental group showed a significant reduction in muscle cramp severity score postintervention,with the mean scores decreasing from 6.83±1.66 to 4.22±1.45(t=10.21,P=0.001).The control group experienced a smaller reduction,with scores decreasing from 6.98±1.57 to 6.43±1.37(t=2.810,P=0.007).Between-group analysis confirmed a significant difference postintervention,with the experimental group improving more(t=8.242,P=0.001).The Mann–Whitney U test also highlighted a significant difference between groups after the intervention(U=494.5,P=0.001),validating the effectiveness of BAE.Conclusion:BAE significantly reduces muscle cramp severity in recently extubated ICU patients,suggesting that this nonpharmacological intervention can effectively improve patient outcomes and aid in postextubation recovery.