Understanding Post-Intensive Care Syndrome: A Journey to Recovery

Intensive care units (ICUs) provide patients with advanced, life-saving treatments during critical illness or following an injury. These environments are crucial for recovery. However, for most patients, recovery doesn’t end when they leave the ICU.

Many survivors experience post-intensive care syndrome (PICS), a condition that can impact their long-term physical, psychological and cognitive well-being. PICS is often labeled by symptoms that go beyond what would be expected for a patient based on their original illness or injury. As health care professionals and families become increasingly aware of PICS, it has become a strong focus in patient recovery journeys.

What is Post-Intensive Care Syndrome?

PICS is a complex condition that emerges after a patient has been in the ICU. It involves three primary areas:

1. Cognitive impairments: Difficulty with memory, concentration, problem-solving and communication
2. Psychological/emotional impairments: Conditions such as post-traumatic stress disorder (PTSD), depression and anxiety
3. Physical impairments: Weakness, fatigue, decreased mobility and insomnia

The causes of PICS are multi-faceted and can differ from one individual to another. Several contributing factors include:

1. Duration of ICU stay: Longer stays in the ICU increase the risk of developing PICS as the likelihood of experiencing physical deconditioning and psychological trauma is greater.
2. Severity of illness: Conditions that require high levels of sedation, mechanical ventilation or involve significant physiological instability can heighten the symptoms of PICS.
3. Pre-existing conditions: Patients with a history of mental illness, cognitive impairment or chronic health conditions may be at increased risk for experiencing PICS.
4. Delirium: Patients who experience delirium in the ICU are at a higher risk for post-ICU cognitive issues. Delirium can complicate recovery and contribute to long-term cognitive decline.

In order to diagnose PICS, a patient undergoes a comprehensive evaluation using cognitive assessments, delirium screenings, psychological questionnaires and physical examinations. for PICS screening are done when a patient’s symptoms are greater than what would be expected from their injury or illness alone.

Prevention of Post-Intensive Care Syndrome

While there is no exact science to prevent PICS, precautions that can be taken while a patient is in an ICU for an extended time. One of the most effective ways to help a patient stay oriented is simply to talk to them. Discuss the current date and time, share updates about family members and mention familiar places or recent events. Connecting to the outside world can ground patients and promote a sense of stability in an otherwise disorienting environment.

Keeping an ICU diary can be therapeutic for both the patient and family. Documenting the journey with thoughts, feelings and significant events can help mitigate feelings of anxiety, depression and PTSD after an ICU stay.

Getting a patient up and moving, if possible, is critical in preventing physical impairments such as ICU-acquired weakness. Mobility also allows patients to participate in activities of daily living, restoring some sense of normalcy.

Rehabilitation

Patients commonly need care after discharge from the ICU and there is no exception for those who experience PICS. A common next step after the ICU is post-acute care at a critical illness recovery hospital. Here, patients with medically complex conditions continue their recovery to regain their quality of life.

The optimal care setting for PICS utilizes a multidisciplinary approach¹. Patients in a critical illness recovery hospital are provided this approach through physical, occupational, speech and respiratory therapy and access to a psychologist.

At a critical illness recovery hospital, patients have individualized care plans that help them overcome both the lasting impact of from their injury or illness as well as symptoms of PICS. The five focus areas of recovery are walking, talking, breathing, thinking and eating.

Walking: After an extended ICU stay, it’s common for patients to have reduced strength and endurance, making walking or any form of movement difficult. Early mobilization during an ICU stay and while in post-acute care is key in preventing and reversing ICU-acquired weakness.

Talking: Having the ability to communicate with family and their care team can greatly help a patient’s mental health. Early use of a speaking valve on patients with a tracheostomy tube and alternative communication devices allow patients to communicate their wants, needs and emotions.

Breathing: Patients commonly need mechanical ventilation to help them breathe after a serious illness or injury. Restoring their ability to breathe independently  again is an important step in recovery. Prolonged use of a ventilator can greater increase a patient’s likelihood of PICS.

Thinking: Cognitive impairments are one of the three primary areas of PICS. Early cognitive rehabilitation helps to retrain the brain and overcome these deficits.

Eating: Patients get enjoyment and normalcy from eating. Restoring their ability to eat not only provides nutrition but helps their mental health.

To learn more about critical illness recovery, contact us or find a location near you.

References:

1 Bemis-Dougherty, A. R., & Smith, J. M. (2013). What follows survival of critical illness? Physical therapists' management of patients with post-intensive care syndrome. Physical therapy, 93(2), 179–185. https://doi.org/10.2522/ptj.20110429