Functional Outcomes in Children Post Critical Illness
Condition: Critical Illness
MeSH terms: Critical Illness
Study type: Observational

Summary: 
      Improvements in medical care have led to decreasing mortality rates in critically ill
      children, which have been reported to be as low as 5%. However, surviving critical illness
      does not necessarily translate to a return to pre-critical illness functional and
      developmental levels. Adult literature has shown that critical illness increases functional
      disability for up to five years post intensive care unit stay. We hypothesize that children
      experience similar functional disabilities as a result of critical illness, which may, as in
      adults, be primarily due to muscle wasting. The aim of this prospective observational pilot
      study is establish the relationship between intensive care unit stay and functional outcomes
      in pediatric survivors of critical illness.
    

Detailed description: 
      Background:

      Mortality rates in critically ill children have decreased significantly in recent years, with
      current rates reported to be as low as 5%. However, increased survival may result in
      significant morbidity. Herridge et al. demonstrated that adults admitted to the intensive
      care unit (ICU) for acute respiratory distress syndrome experienced functional disability
      which persisted up to 5 years after their ICU stay. There now exists a substantial body of
      literature that adult critical care survivors suffer significant impairment in their quality
      of life, which is a growing public health issue.

      In critically ill children, Namachivayam et al. showed that among children with pediatric
      intensive care unit (PICU) stay > 28days, 34% of survivors had an unfavourable functional
      outcome (defined as moderate or severe disability with dependence on others for care as
      measured by the Glasgow Outcome Scale). Health related quality of life was also affected,
      with 68% of survivors having poorer quality of life scores as measured by the Health State
      Utilities Index. Thus, clinicians have argued that mortality may not be the most meaningful
      outcome measure for PICU patients. Alternative outcome measures such as functional status and
      quality of life of children post critical illness may give a better overall assessment of how
      well children cope with surviving critical illness, and how their normal development is
      affected.

      In adults there is a growing understanding of the burden of critical care survivors on
      families and caregivers. Limited data exists regarding the families and caregivers of
      survivors of pediatric critical illness, and local data is lacking.

      Aim:

      The investigator's aim is to assess the impact of critical illness on functional outcomes in
      survivors of pediatric critical illness, as well as the impact on the caregivers.

      Hypotheses:

        1. Children surviving critical illness demonstrate significant functional impairment that
           persists for up to 12 months.

        2. Caregivers of children surviving critical illness experience prolonged lower quality of
           life and significant economic stress.

        3. Low muscle mass secondary to muscle wasting is highly associated with said functional
           disability.

      Specific objectives:

        1. To describe short and long term functional outcomes in pediatric survivors.

        2. To describe the relationship between muscle wasting and functional outcome measures.

        3. To elucidate the relationship between pediatric critical illness survivor functional
           outcomes and caregiver's long term quality of life and lost workdays.

        4. To establish the relationship between in-PICU and in-hospital nutrition and physical
           activity and functional outcomes after a year.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Critically ill children will be recruited during their PICU stay at KK Women's and
        Children's Hospital. They will be followed throughout their PICU stay, at hospital
        discharge, and 6-12 months post discharge.

        Healthy controls will be recruited from the general public by word of mouth. They will
        undergo assessments at a single time-point.
      
Keywords: Functional outcomes; Skeletal muscle