Post-intensive care syndrome
[1] Generally, PICS is considered distinct from the impairments experienced by those who survive critical illness and intensive care following traumatic brain injury and stroke.
[2] Because the majority of literature in critical care medicine is focused on short-term outcomes (e.g. survival), the current understanding of PICS is relatively limited.
The term PICS arose around 2010, at least in part, to raise awareness of the important long-term dysfunctions resulting from treatment in the intensive care unit (ICU).
[1] Increased awareness in the medical community has also highlighted the need for more hospital and community-based resources to more effectively identify and treat patients with PICS after surviving a critical illness.
A current and holistic definition of PICS is the new or worsening impairment to the physical, mental, cognitive, employment, and/or social domains of health following critical illness.
[6] As research on the impairment to physical, mental, and cognitive health resulting from critical illness accumulated, the significance and relationship of these long-term issues was recognized.
[2] The impairments to physical, mental, and cognitive health grouped within PICS increased awareness, research, and education on consequences observed in survivors of critical illness.
[9] However, the recognition that unemployment due to critical illness can negatively affect well-being and quality of life, is a recent finding.
In order to care for PICS, clinicians and researchers need to recognize all impairments experienced by survivors of critical illness.
[citation needed] ICU-acquired weakness (ICU-AW), sometimes called critical illness polyneuropathy, is the most common form of physical impairment, and is estimated to occur in 25 percent or more of ICU survivors.
[17] In people who experience acute respiratory distress syndrome and are treated with mechanical ventilation, lung function is often compromised for months to years.
Like ICU-acquired weakness, long-term immobility and deep sedation have been known to play an important part in the development of mental health problems seen in PICS.
The natural history for mental health disorders following critical illness is not well known, likely due to lack of recognition that these psychiatric symptoms may be related to a remote ICU admission.
[35] Healthcare providers, especially clinical social workers who specialize in medical care, can be very helpful in advocating these practices and facilitating them for patients and families.
[2][10] Employment is critical to health and wellbeing as it provides daily structure, financial security, identity, autonomy, opportunities for development, and regular social engagement.
Increasing awareness of PICS has also brought to light a set of psychological symptoms that family members of critically ill patients often experience.
Family members can also feel overwhelmed when they are asked to make unexpected life and death decisions about the care of their loved ones.
Patients' families often experience some of the similar stresses as the ICU patients themselves, including sleep deprivation and severe psychological stresses an unfamiliar and uncomfortable environment – Particular attention from healthcare workers, especially medically trained clinical social workers and critical care nurses, can be helpful to identify those families who are at risk and to provide advice and resources whenever possible.
They often offer support groups for patients and families affected by PICS and PICS-F.[citation needed] Patients and caregivers should look for signs and symptoms associated with PICS or PICS-F including muscle weakness, fatigue, trouble with daily activities, memory or thinking problems, anxiety and depression, or nightmares and unwanted memories after leaving the ICU.
By defining PICS holistically, to include the five impairments previously outlined, research and education can be catered towards preventing, mitigating, or resolving these issues.
[44] By providing comprehensive education on PICS impairments, ICU patients and families will be aware of symptoms to monitor for post-discharge and understand resources are available as needed.
In a UK study, PICS patients reported not accessing mental health resources they needed due to lack of education.
[2] As such, nurses can assess patients for PICS impairments, identify their goals for recovery, and provide appropriate resources or referrals.
Nurses are in an opportune position to assist PICS patients with their holistic needs and help them navigate the healthcare system.
A holistic perspective is required for PICS in order to recognize the full range of impairments experienced after critical illness.
The comprehensive, holistic, and modern definition of PICS can improve the care of critical illness survivors from this day forward.
