Diagnosis and management of Children with Post-Intensive Care Syndrome in Paediatrics: Clinical Practice Guidelines by the French National Authority for Health (HAS)

Objective: Advances in paediatric intensive care have resulted in a growing population of survivors exposed to long-term morbidity. Paediatric post-intensive care syndrome (PICS-p) encompasses new or worsened physical, cognitive, psychological/psychiatric, and socio-familial impairments that may affect children and their families after discharge from the paediatric intensive care unit (PICU). Despite increasing recognition of PICS-p, post-PICU follow-up remains highly heterogeneous worldwide, and systematic screening and management strategies are rarely integrated into routine care. These guidelines were issued at the initiative of the French national health authority (Haute Autorité de Santé: HAS) to improve the prevention, identification, and management of PICS-p. Design: Clinical practice guidelines developed following the HAS standardized methodology (Recommandations de Bonne Pratique), including systematic literature review, multidisciplinary expert elaboration, formal external review, and HAS board approval. Reporting follows the AGREE II framework. Methods: Clinical questions were predefined by HAS project leads. A systematic literature search ([dates]) was conducted across Embase, EmCare, Medline, and the Cochrane Library, prioritising guidelines, meta-analyses, and systematic reviews. Two field experts drafted initial recommendations, graded A (established evidence) to Expert Opinion (absence of evidence). An 18-member multidisciplinary working group refined the draft through two in-person meetings. A 52-member external review panel formally voted on agreement for each recommendation. The final version was approved by the HAS board. Results: Fourty recommendations were issued: 5 with a moderate level of evidence (grade B), 8 low level (grade C) and 27 very low (expert opinion). Strong agreement by the panel of experts was achieved for all recommendations except for one (moderate). The recommendations define PICS-p as a prevalent, multidimensional condition and emphasize systematic, repeated screening of children and families from PICU admission through the first year after discharge. Key preventive strategies include implementation of ABCDEFGH bundle, early mobilization, optimized analgesia and sedation, delirium prevention, and family-centred psychological support. Structured care pathways and pragmatic screening tools are proposed to ensure continuity of care. Conclusion: These guidelines emphasize the importance of structured, multidisciplinary, and family-centred strategies, to improve the prevention, early identification, and management of PICS-p and optimize long-term outcomes for children and their families.