Outcomes Research in the PICU

Pediatric critical care involves the delivery of care to children with severe illness or in need of close cardiopulmonary monitoring after a surgical procedure. In areas of the world where these critical care services are available and accessible, mortality has been on the decline over the past two decades. This gratifying result of intensive care and of biomedical advancement as a whole, has led to ever-increasing calls for measurement of the functional status and quality of life of survivors of critical illness. The ultimate goal of pediatric intensive care is to provide survival without impairment. Implicit in this assertion is the need to ensure that a child who survives intensive care is able to perform daily activities in a manner and range considered normal, meet basic needs, fulfill roles, and maintain health and well-being. The ensuing treatise will highlight the fact that majority of critically ill children survive hospitalization, however; they might be impaired or disabled thereafter. It is being increasingly recognized that while a child with disability resulting from critical illness, might adjust over time and be able to rate the quality of their life as good, normal, or acceptable; impairment (and resulting disability), is a poor outcome for pediatric intensive care. Focus on survival status alone will lead to omission of these vital patient-centered outcomes of functional status and quality of life. In the ensuing discourse, outcomes of critical care will be defined, along with methods to measure them. It will be evident that very few studies of functional status and health-related quality of life have been performed in pediatric intensive care, a pressing concern that needs to be addressed to enlighten important stakeholders, including patients and their caregivers, governmental and other regulatory agencies, and critical care providers about the value of pediatric intensive care that reaches far beyond survival status.