What Is Post-intensive Care Syndrome?

Context

Various news reports in recent weeks have pointed out that for some Covid-19 patients who needed intensive care, the journey to recovery is a long one. After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU. Significantly, Acute Respiratory Distress Syndrome (ARDS), one of the manifestations of Covid-19, is a common reason for ICU admission and such a person may need mechanical ventilation to deliver oxygen and remove carbon dioxide from the body.

What is post-intensive care syndrome?

According to an article in the Journal of Translational Internal Medicine, PICS comprises impairment in cognition, psychological health and physical function of a person who has been in the ICU.
“PICS is defined as new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting,” the article notes.
Further, such patients may experience neuromuscular weakness, which can manifest itself in the form of poor mobility and recurrent falls.
Psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).
The most common PICS symptoms are generalised weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues. These symptoms may last for a few months or many years after recovery, the authors of the aforementioned article note.

PICS may be induced if a person was on prolonged mechanical ventilation, experienced sepsis, multiple organ failure and a prolonged duration of “bed-restore deep sedation”.
As per the Cleveland Clinic, a combination of factors can affect aspects of an ICU survivor’s life.
According to the Society of Critical Care Medicine (SCCM), 33 per cent of the people on ventilators may develop ICU-acquired muscle weakness (ICUAW). Along with this, 50 per cent of those who develop sepsis and up to 50 per cent of the patients who stay in the ICU for at least one week are also prone to ICUAW.
Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.
Further, after leaving the ICU, over 30-80 per cent may develop problems related to cognitive function and other mental health issues, including difficulty in falling and staying asleep. According to SCCM, while up to 50 per cent of patients may return to work within the first year, some may not be able to return to the jobs they had before illness.

It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.
Further, patients should be given the lowest dose of pain medications when possible, and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.