In the early days of caring for critically ill patients with acute respiratory distress syndrome, sepsis or multiple organ failure, we were grateful when they survived their illness. We used any interventions we could think of to increase the likelihood of survival. We didn’t really think about what came after patients’ intensive care unit (ICU) experience; we were just happy they survived. However, we came to find out that despite our best efforts, these patients had a high risk of developing delirium and post discharge sequelae.
What are the symptoms of post-intensive care syndrome (PICS)?
Patients with PICS may have new or worsening brain (cognitive), emotional and/or physical symptoms. The symptoms start after the critical illness, persist after discharge from the ICU and can last for weeks, months and even years.
Brain (cognitive) symptoms:
- Decreased memory, thinking problems
- Difficulty talking
- Poor concentration
- Trouble organizing and problem solving
- Post-traumatic stress disorder (nightmares, unwanted memories)
- Decreased motivation
- Muscle weakness
- Decreased mobility
- Difficulty breathing
What causes post-intensive care syndrome (PICS)?
Post-intensive care syndrome (PICS) results from the combination of factors. Care in the ICU can be intense due to the serious medical conditions themselves (such as respiratory failure, sepsis), use of life-sustaining equipment (such as endotracheal tubes, mechanical ventilators); and use of sedative, pain and other medications that have mind-altering (including delusional) effects. Patient exposure to all of these unique stressors can affect many aspects of the ICU survivor’s life.
How is post-intensive care syndrome (PICS) diagnosed?
Physicians use cognitive impairment screening tests to evaluate mental functions. Stress and anxiety disorders and depression can also be assessed with screening questionnaires. Physical weakness due to the prolonged bed rest and illness is easily diagnosed with physical exam and medical history. Pain and delirium are also carefully assessed.
MANAGEMENT AND TREATMENT
Different approach can be used to prevent and treat PICS. Which includes:
- Using light or minimal sedation.
- Providing the lowest dose needed to manage pain.
- Monitoring for and managing delirium.
- Getting the patient moving as soon as possible in the ICU. Even after the ICU stay, physical therapists and occupational therapists can continue to reduce weakness and improve physical functioning.
- Recommending pulmonary (lung) or cardiovascular (heart) rehabilitation (if appropriate) due to the high prevalence of respiratory and cardiovascular disease in patients after ICU discharge.
- Treating depression, anxiety and post traumatic stress disorder with a combination of medications, psychological and behavioral therapies.
- Avoiding hypoglycemia (low blood sugar levels) and hypoxemia (low oxygen levels).
- Encouraging the patient and family members to keep an ICU diary.
- Providing follow-up counseling with a psychologist or psychiatrist for patients with emotional symptoms.
- Advising the patient to get an adequate amount of sleep and to eat healthy.
How can family members help their loved one with post intensive care syndrome (PICS)?
Family members can help to decrease the effects of PICS by helping their family member stay “oriented” and encouraging exercise, beginning in the ICU.
- Talk about the current date and time and familiar people, places and current events.
- Bring in pictures or favorite items from home.
- Keep an ICU diary to help cope with anxiety, depression and post-traumatic stress disorder.
- Read stories aloud at the bedside.
- Participate in activities such as card games or puzzles.
- Encourage sleep during the night and activity during the day.
- Ask the health care team to teach you how to help with exercise and bedside care.
How can family members who have post-intensive care syndrome (PICS-F) help themselves?
- Talk with the health care team about the plan of care.
- Try to continue a normal daily routine by eating well, getting rest and exercising.
- Seek support from family or friends.
- Participate in bedside care.
- Family members with ongoing emotional symptoms may need to see a professional counselor, psychologist or psychiatrist.
Society of Critical Care Medicine: Connect with Patients and Families.