ROP 2020 July 10th Breaking News: Post-Intensive Care Syndrome

Post-Intensive Care Syndrome 

Heidi James, MD and Vanessa Cardy, MD

ICU admission rates have increased due to COVID-19, which means that more of our patients will suffer from post-intensive care syndrome (PICS). 

• PICS is a constellation of symptoms
• Cognitive deficits
• Memory
• Concentration
• Executive functioning
• Increased risk of dementia
• Psychological 
• Depression
• Anxiety
• PTSD
• Physical symptoms
• Fatigue
• Weakness
• Symptoms may impact patients for the short term, but many are disabled by them for the long term.
• Prevention is key
• Minimize risk of delirium,
• Avoid the hypos: hypoxia, hypoglycemia, hypotension
• The ABCDEFGH approach is a helpful framework to follow to decrease risk of PICS. 
• A - Awakening (use minimal amount of sedation as possible)
• B - Breathing (do spontaneous breathing trials)
• C -  Coordination of care and communication
• D - All thing delirium
• E - Early ambulation and physical therapy
• F - Functional reconciliation (what was their level of function at baseline?), family involvement and follow-up plans
• G - Good communication between team members. 
• H - hand out materials for patients and their families 
• Many are impacted by their symptoms long past their discharge from ICU, primary care providers will be managing these patients and will become experts in their care. 

References

Functional disability 5 years after acute respiratory distress syndrome
Herridge, Margaret S., et al. New England Journal of Medicine 364.14 (2011): 1293-1304.
https://doi.org/10.1056/NEJMoa1011802

Post-intensive care syndrome: An overview
Rawal, Gautam, Sankalp Yadav, and Raj Kumar. Journal of translational internal medicine 5.2 (2017): 90-92.
https://doi.org/10.1515/jtim-2016-0016 

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions
Inoue, Shigeaki, et al. Acute Medicine & Surgery 6.3 (2019): 233-246.
https://doi.org/10.1002/ams2.415

A Clinic Model: Post–Intensive Care Syndrome and Post–Intensive Care Syndrome-Family
Huggins, Elizabeth L., et al. AACN advanced critical care 27.2 (2016): 204-211.
https://doi.org/10.4037/aacnacc2016611

Home and community-based physical therapist management of adults With post–intensive care syndrome
Smith, James M., et al. Physical Therapy (2020).
https://doi.org/10.1093/ptj/pzaa059

The New York Times: Here’s What Recovery From Covid-19  Looks Like for Many Survivors
https://www.nytimes.com/2020/07/01/health/coronavirus-recovery-survivors.html