What is Post-intensive Care Syndrome?

Updated: Feb 11


post-intensive care syndrome (PICS)

Post-intensive care syndrome or in short, PICS is a collective term used for various physical, emotional as well as mental symptoms that may continue persisting even after any particular patient gets discharged from an ‘intensive care unit’ facility (ICU). Due to numerous advancements in medical healthcare during the last few decades, the number of individuals surviving most of the critical diseases is increasing day by day. Clinicians must be focusing on moreover immediate outcomes of the short-lived nature of this syndrome in patients. In recent times, medical healthcare professionals have slowly shifted the attention to the long-term outcomes of survivors of critical diseases that can result in admissions in ICU. It has been noted that though survival in Intensive Care Units has demonstrated improvement, patients have not been shown to resume their former level of activity which can be lasting for weeks, months as well as many years. Patients have been shown to develop symptoms related to one’s mind, mental status as well as psychological symptoms that may be related to the respective critical nature of the illness along with treatment administered in the Intensive Care Unit.


Apart from the patients with critical illness and who have survived after staying in an intensive care unit, the patient's family as well as the near and dear ones i.e., the caregivers who provided required care along with emotional support may also be developing a few of these symptoms related to mental as well as emotional involvement of PICS. This condition has been called ‘PICS-family’ or (PICS-F). Post-Intensive Care Syndrome influences the quality of life in both patients as well as their families.


How is this diagnosed?

Post-intensive Care Syndrome |

Patients suffering from Post-Intensive Care Syndrome are diagnosed by Healthcare professionals based on new and worsening cognitive, emotional, or physical symptoms that begin after any critical stage illness and may continue to persist even after getting discharged from ICU. These symptoms may be lasting for a varying duration that can last from a few weeks, months, or years. Symptoms associated with cognition include a Decrease in memory, Problems in thinking, Difficulty while talking, Forgetful nature, Inability to concentrate, and trouble in organizing as well as solving problems.


Symptoms related to emotional changes include Post-traumatic stress disorder (for instance, nightmares), Anxiety, Depressive moods, and reduction in motivation. Symptoms related to physical well-being include Weakness in muscles, Development of fatigue, Reduction in mobility, Difficulty in breathing, and lack of sleep (Insomnia). Symptoms of PICS-F among caregivers include: Anxiety, Depression, Feeling of overwhelm, Grief, Stress, Post-traumatic stress disorder, and disturbances in sleep. At Centric Healthcare, a wholesome diagnostic criterion is followed by a team of doctors to arrive at the diagnosis and also, devising a management plan.



How is Post-intensive care syndrome treated?

Post-intensive Care Syndrome Treatment

The healthcare experts make use of various approaches for prevention as well as treatment of Post-intensive care syndrome. These approaches may include the use of light and minimal sedation by administering the least dose that is required for managing pain, for monitoring and managing delirium, and for making a patient mobile as early as possible while he or she is admitted in ICU. Even the following discharge from ICU, physiotherapists along with occupational therapists may continue their therapy for reducing weakness as well as improving physical ability.


A healthcare person will recommend pulmonary i.e., lung or cardiovascular or heart rehabilitation if it is appropriate due to high occurrence of respiratory as well as cardiovascular diseases in most of the patients after getting discharged from the Intensive Care Unit.


Similarly, specialists at Centric Healthcare treat depression along with anxiety as well as post-traumatic stress disorder by using varied combinations of medicines, and psychological as well as behavioral treatment, if needed. Patients and their caregivers are advised by a physician to avoid hypoglycemia or lowered levels of blood sugar along with conditions of hypoxemia that is characterized by decreased levels of oxygen in the blood.


Healthcare providers including those at Centric Healthcare encourage a patient and their close family relatives to maintain a diary to monitor the patient’s overall general health. One of the practices followed at Centric Healthcare is to provide follow-up sessions of counseling with a trained psychologist and/or psychiatrist for managing patients who have emotional issues or symptoms. And most importantly, all patients are advised to have adequate sleep and eat healthy food.


Who are most affected and why?

Post-Intensive Care Syndrome may affect individuals in a variety of ways. Due to this, methods of managing various symptoms of post-intensive care syndrome might be different among various individuals. Although, there may be a few basic strategies for managing patients with PICS that may be of help in the recovery of a patient. Most importantly, a patient should not miss any appointments in the hospital after spending some time in the Intensive Care Unit. Apart from examining one’s physical health for which the patient was originally admitted, a healthcare professional must also be looking for any other symptoms related to mental, emotional, or physical stress.


Professionals at Centric Healthcare are inclined to identify any symptoms of Post-Intensive Care syndrome. Identified subjects are then advised for management of their general wellness by following various steps such as by adopting healthy habits of sleeping, consuming a healthy diet, maintaining as much physical activity as possible, and performing activities that can keep one's mind fully occupied.


Post-Intensive Care Syndrome may affect any person who has been suffering from a critical stage of any illness, however, it may also be affecting the individuals who are helping them in the process of recovery. Also, strains on either mental or financial status or both may be a major factor for developing this syndrome.



What are the preventive measures for post-intensive care syndrome?

One of the most important prevention strategies is the minimization of dosages of sedation that might be affecting major symptoms’ categories i.e., physical, emotional, and psychological states of Post-Intensive Care Syndrome. Healthcare professionals at Centric Healthcare also encourage these patients to start moving around as early as possible whenever they have started recovery.


All healthcare facilities might be using “A, B, C, D, E, F” approaches for preventing the onset of symptoms after any person gets discharged from ICU. Each of these letters represents slight variations in their meanings among different facilities, although the overall principles involved remain the same. Meaning of this approach are as under-

  • A - Awakening: In this approach, any healthcare personnel might be able to decrease sedatives or make use of bright light for waking any person

  • B - Breathing approach: In this, healthcare personnel can temporarily remove a person from the mechanical ventilator to check if they still require assisted trials

  • C - Coordination of healthcare: Healthcare experts make coordinated efforts among themselves for providing best treatment

  • D - Delirium: A healthcare person also, monitors mental stability of a patient

  • E - Early initiation of exercises: Medicalstaff at Centric Healthcare aims in making these individuals achieve mobility so that they can begin to walk without any assistance as early as possible and

  • F - Family empowerment




References

  1. https://www.mayoclinic.org/departments-centers/critical-care/sections/overview/ovc-20399554

  2. https://www.aafp.org/afp/2009/0315/p459.html

  3. https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome

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