A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness. (Land)

Kachmar AG, et al. A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness. Pediatr Crit Care Med. 2018 Mar;19(3):e164-e171.

OBJECTIVES: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.

DATA SOURCES: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.

STUDY SELECTION: Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.

DATA EXTRACTION: Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.

DATA SYNTHESIS: Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these-four case-control and three prospective cohort studies-reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.

CONCLUSIONS: Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.

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