Post-Intensive Care Syndrome

Recently, 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.

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.
It comprises impairment in cognition, psychological health and physical function of a person who has been in the ICU.
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).

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”.
Nearly, 33 percent of the people on ventilators may develop ICU-acquired muscle weakness (ICUAW).
Along with this, 50 percent of those who develop sepsis and up to 50 percent of the patients who stay in the ICU for at least one week are also prone to ICUAW.
Further, after leaving the ICU, over 30-80 percent may develop problems related to cognitive function and other mental health issues, including difficulty in falling and staying asleep.

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.

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.