as rates of adhd, anxiety, depression, sleep problems and learning disabilities soar in canadian children, we may be missing a huge opportunity for early intervention. to fill this gap, some picu clinicians are calling for the establishment of post-icu follow-up clinics, similar to those for babies who survive a neonatal icu.
canada’s first pediatric post-icu clinic was established in september 2018 at the centre hospitalier universitaire sainte-justine (chu sainte-justine) in montreal, the largest mother and child centre in canada. laurence ducharme-crevier, a pediatric intensive care physician, founded the clinic along with a colleague. “one of the main reasons to start the clinic was to see what the outcomes in these children are after critical illness,” she says. “we need this information so that change can continue happening in the picu itself.”
ducharme-crevier tells the story of one of her sickest patients — a 200-pound, 6-foot-tall teen who had been admitted to the picu with viral encephalitis, an inflammatory condition of the brain. the critical care team was almost certain that the teen — intubated, sedated and paralyzed — was going to die.
“but then he got better,” she says. “he left the picu waving goodbye with a smile on his face, and we were elated. two months later we saw him at the follow-up clinic. he had forgotten how to take a shower, left boiling water on the stove and was giving money to kids on the street. this child — our miracle — was nowhere close to any semblance of his normal life.”
research
shows that a picu follow-up clinic could be well-suited to monitor and support symptoms of pics-p in picu survivors. they would be able to screen for anxiety, depression, ptsd, emotional and behavioural problems, hyperactivity and school problems. this can allow children and parents to be referred to supports as early as possible, including additional support at school. it can also allow for increased awareness for primary health-care providers on the far-reaching effects of pics-p.