Program Code: SCF-DBI-PICU-RECOVERY-0001
Operational Window: Physiologic Stabilization → Step-Down Care → Hospital Discharge → Long-Term Follow-Up
Primary Objective: Transition pediatric patients from survival-focused critical care to biologic intelligence restoration, neurodevelopmental preservation, functional recovery, educational reintegration, and long-term resilience.
SECTION 10.1
CLINICAL POSITIONING
Traditional PICU Recovery Model
Recovery is frequently defined as:
- Extubation
- ICU discharge
- Organ stabilization
- Hospital discharge
SCF-DBI Recovery Model
Recovery is defined as restoration of:
Neurocognitive Intelligence
Neuroimmune Intelligence
Neurovascular Integrity
Functional Independence
Developmental Trajectory
Educational Participation
Family Adaptation Capacity
Core Principle
Recovery begins on Day 1 of PICU admission.
Every intervention must contribute to future resilience.
SECTION 10.2
PICU RECOVERY INTELLIGENCE PROGRAM (PRIP)
Purpose
Coordinate comprehensive recovery across all critical care domains.
Recovery Domains
Domain 1
Neurocognitive Recovery
Domain 2
Respiratory Recovery
Domain 3
Cardiovascular Recovery
Domain 4
Immune Recovery
Domain 5
Nutritional Recovery
Domain 6
Functional Recovery
Domain 7
Educational Reintegration
Domain 8
Family Recovery
SECTION 10.3
RECOVERY READINESS INDEX (RRI)
Purpose
Determine readiness for:
Step-down care
Transfer
Hospital discharge
Community reintegration
RRI Domains
Physiologic stability
Functional status
Neurocognitive recovery
Nutritional adequacy
Family readiness
Recovery intelligence status
Classification
Green
RRI >80
Ready for progression
Yellow
RRI 60–79
Recovery optimization needed
Orange
RRI 40–59
Delayed recovery risk
Red
RRI <40
High vulnerability
SECTION 10.4
VENTILATOR LIBERATION SOP
Strategic Position
Extubation is viewed as:
Recovery Intelligence Milestone
rather than simply:
Removal of respiratory support
Liberation Readiness Domains
Respiratory
Oxygenation
Ventilation
Airway protection
Hemodynamic
Perfusion stability
Lactate normalization
Neurologic
Mental status
Cognitive engagement
SCF
Stable ANMS
Stable EII
Improving recovery trajectory
Liberation Pathway
Mechanical Ventilation
↓
Non-Invasive Support
↓
Low-Flow Support
↓
Room Air
SECTION 10.5
EARLY MOBILITY & REHABILITATION SOP
Purpose
Prevent:
ICU-acquired weakness
Functional decline
Delayed recovery
Educational disruption
Mobility Levels
Level 0
Passive range of motion
Level 1
Bed mobility
Level 2
Sitting activities
Level 3
Standing activities
Level 4
Ambulation
Level 5
Age-appropriate activity participation
SECTION 10.6
PICU-ACQUIRED WEAKNESS PREVENTION PROGRAM
Strategic Position
Weakness is viewed as:
Recovery Intelligence Erosion
Prevention Components
Early mobility
Nutrition optimization
Sleep preservation
Sedation minimization
Rehabilitation planning
Monitoring Variables
Strength
Endurance
Functional status
Recovery trajectory
SECTION 10.7
RHENOVA FUNCTIONAL RECOVERY PLATFORM
Objectives
Restore:
Mobility
Self-care
Communication
Learning capacity
Physical resilience
Recovery Modules
Physical Recovery
Cognitive Recovery
Behavioral Recovery
Social Recovery
Educational Recovery
SECTION 10.8
NEUROCOGNITIVE RECOVERY PROGRAM
Strategic Objective
Preserve and restore:
Attention
Memory
Executive functioning
Learning ability
Developmental progression
Surveillance Variables
Cognitive status
Delirium status
Sleep quality
Family interaction
Educational engagement
Cognitive Recovery Classification
Green
Expected recovery
Yellow
Mild delay risk
Orange
Moderate impairment risk
Red
High impairment risk
SECTION 10.9
POST-ICU SYNDROME IN CHILDREN (PICS-P) PREVENTION PROGRAM
Core Domains
Physical
Cognitive
Emotional
Social
Educational
Prevention Strategies
Early rehabilitation
Cognitive stimulation
Family engagement
Sleep preservation
Recovery intelligence surveillance
SECTION 10.10
SCHOOL REINTEGRATION PATHWAY
Strategic Position
School participation is a major recovery endpoint.
Assessment Domains
Cognitive readiness
Physical readiness
Behavioral readiness
Social readiness
Reintegration Levels
Level 1
Home educational support
Level 2
Partial school participation
Level 3
Modified full participation
Level 4
Full participation
SECTION 10.11
FAMILY RECOVERY & ADAPTATION PROGRAM
Objectives
Prepare caregivers for:
Medical management
Functional support
Educational advocacy
Recovery monitoring
Psychosocial adaptation
Core Components
Family education
Recovery planning
Transition support
Community resource linkage
SECTION 10.12
RHENOVA PEDIATRIC RECOVERY INTELLIGENCE TRANSFER PACKAGE (PRITP)
Purpose
Provide continuity from PICU to home and community.
Package Components
Clinical Summary
Diagnoses
Procedures
ICU course
Recovery Intelligence Summary
ANMS trajectory
STRI trajectory
EII trajectory
NCRS trajectory
RRI trajectory
Functional Summary
Mobility status
Cognitive status
Educational readiness
Follow-Up Plan
Medical follow-up
Rehabilitation follow-up
Neurocognitive follow-up
Educational support
SECTION 10.13
PICU STEP-DOWN TRANSITION SOP
Transfer Criteria
Stable hemodynamics
Stable respiratory status
Stable neurologic status
Improving functional status
Stable ANMS
Monitoring During Transition
Functional progression
Recovery trajectory
Family readiness
SECTION 10.14
DISCHARGE READINESS FRAMEWORK
Clinical Criteria
Organ stability
Respiratory stability
Hemodynamic stability
Functional Criteria
Mobility progression
Self-care progression
Rehabilitation plan established
SCF Criteria
ANMS >80
STRI >80
EII stabilized
NCRS stabilized
RRI >80
SECTION 10.15
RECOVERY INTELLIGENCE ENDPOINTS
Clinical
Hospital recovery
Organ recovery
Reduced readmission risk
Functional
Mobility restoration
Educational participation
Cognitive preservation
Biological Intelligence
ANMS normalized
STRI normalized
EII normalized
NCRS normalized
Recovery trajectory sustained
PAGE 10 COMPLETION
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