Overview and management of post-intensive care syndrome
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20233133Keywords:
Post-intensive care syndrome, Critical illness, Intensive care unit, PICS prevention and intervention, PICSAbstract
Any patient suffering from critical life-threatening illnesses in most cases require hospitalization, in the care unit (ICU) where they can receive essential life-sustaining treatments. This has created an impact including more than 50 million individuals world-wide. Although advancements, in technology and healthcare have increased survival rates many individuals who survive these illnesses experience long-term impairments known as post-intensive care syndrome (PICS). PICS encompasses cognitive and emotional challenges that significantly affect patients' quality of life and ability to return to their normal routines. Caregivers may also face similar emotional hurdles, a condition referred to as PICS-family (PICS-F). The prevalence of PICS varies but can affect up to 50% of ICU survivors. Cognitive difficulties can be noticed in, around 70% of instances impacting abilities like memory, focus, and decision-making. These difficulties can lead to emotions such, as sadness worry, and a condition known as traumatic stress disorder (PTSD). Multiple factors, such as delirium, sedation, and pre-existing health conditions play a role, in the emergence and severity of PICS. Diagnosing PICS involves comprehensive assessments covering physical, cognitive, and emotional dimensions. Screening should ideally commence during the ICU stay and continue post-discharge. Assessment tools such as the Montreal cognitive assessment (MoCA) and emotional functioning screenings aid in identifying PICS. This manifests physically through muscle weakness and fatigue, impacting mobility and daily activities. Effectively managing ICUs requires the implementation of models and strategies that optimize resource utilization. However, these strategies may entail challenges such as data integration and stakeholder involvement. Preventing PICS involves proactive measures like reducing sedation, promoting early mobility, and offering rehabilitation services. Addressing PICS necessitates a proactive approach, comprehensive patient care, and collaboration among multidisciplinary teams. The successful implementation of these strategies depends on thorough evaluation and active engagement with all stakeholders involved in ICU management.
Metrics
References
World Health Organization. World Health Statistics 2022. 2022. Avalable at: https://www.who.int/news/ item/20-05-2022-world-health-statistics-2022. Accessed on 12 June 2023.
Pallanch O, Ortalda A, Pelosi P, Latronico N, Sartini C, Lombardi G, et al. Effects on health-related quality of life of interventions affecting survival in critically ill patients: a systematic review. Crit Care. 2022;26(1).
Bose S, Hoenig B, Karamourtopoulos M, Banner-Goodspeed V, Brown S. Beyond survival: identifying what matters to survivors of critical illness. Crit Care. 2021;25(1).
Saqib M, Iftikhar M, Neha F, Karishma F, Mumtaz H. Artificial intelligence in critical illness and its impact on patient care: a comprehensive review. Front Med. 2023;10.
Rousseau AF, Prescott HC, Brett SJ, Weiss B, Azoulay E, Creteur J, et al. Long-term outcomes after critical illness: recent insights. Crit Care. 2021;25(1):108.
Huggins EL, Bloom SL, Stollings JL, Camp M, Sevin CM, Jackson JC. A clinic model: post–intensive care syndrome and post–intensive care syndrome-family. AACN Adv Crit Care. 2016;27(2):204-11.
Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother. 2021;21(10):1159-77.
Berger P, Braude D. Post–intensive care syndrome: Screening and management in primary care. Aust J Gen Pract. 2021;50:737-40.
Ohtake PJ, Lee AC, Scott JC, Hinman RS, Ali NA, Hinkson CR, et al. Physical Impairments Associated With Post-Intensive Care Syndrome: Systematic Review Based on the World Health Organization's International Classification of Functioning, Disability and Health Framework. Phys Ther. 2018;98(8):631-45.
Raman R, DesAutels SJ, Lauck AM, Scher AM, Walden RL, Kiehl AL, et al. Instruments Assessing Cognitive Impairment in Survivors of Critical Illness and Reporting of Race Norms: A Systematic Review. Crit Care Explor. 2022 D;4(12):e0830.
Marra A, Pandharipande PP, Girard TD, Patel MB, Hughes CG, Jackson JC, et al. Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness. Crit Care Med. 2018;46(9):1393-401.
Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-Term Cognitive Impairment after Critical Illness. N Engl J Med. 2013;369(14):1306-16.
Dean EA, Biehl M, Bash K, Weleff J, Pozuelo L. Neuropsychiatric assessment and management of the ICU survivor. Cleveland Clin J Med. 2021;88(12):669-79.
Gordon SM, Jackson JC, Ely EW, Burger C, Hopkins RO. Clinical identification of cognitive impairment in ICU survivors: insights for intensivists. Intens Care Med. 2004;30(11):1997-2008.
American thoracic society. Patient Education | Information Series. Available at: https://www. thoracic.org/patients/patient-resources/. Accessed on 12 June 2023.
Rawal G, Yadav S, Kumar R. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017;5(2):90-2.
Medrinal C, Prieur G, Bonnevie T, Gravier FE, Mayard D, Desmalles E, et al. Muscle weakness, functional capacities and recovery for COVID-19 ICU survivors. BMC Anesthesiol. 2021;21(1):64.
Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF, Jr. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171(4):340-7.
Rawal G, Yadav S, Kumar R. Post-Traumatic Stress Disorder: A Review from Clinical Perspective. The Int J Indian Psychol. 2016;3:156-64.
Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med. 2014;2(5):369-79.
Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024-36.
Valsø Å, Rustøen T, Småstuen MC, Ekeberg Ø, Skogstad L, Schou-Bredal I, et al. Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Crit Care Med. 2020;48(12):e1218-25.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874-82.