Persistent problems and recovery after critical illness

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0395 ◽

2020 ◽

pp. 3925-3930

Author(s):

Mark E. Mikkelsen ◽

Theodore J. Iwashyna

Keyword(s):

Mental Health ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Side Effects ◽

Physical Function ◽

Critically Ill Patients ◽

Organ Injury ◽

Post Intensive Care Syndrome ◽

Functional Problems

Post-intensive care syndrome is defined as new or worsening impairment in cognition, mental health, or physical function that persists after a critical illness. The complexities of post-intensive care syndrome come from the interactions of the patient’s premorbid mental health and physical function, the acute physiologic derangements and acute organ injury of the critical illness, and the side effects of procedures, treatments, and potential complications incurred during the critical illness. Problems are better described as challenging syndromes rather than specific actionable diagnoses, with the four major functional problems for patients being weakness, cognitive impairment, psychological problems, and new or worsened organ dysfunction. The sequelae of critical illness often extend beyond patients and impact the families of critically ill patients.

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Testimonies in Understanding the Psychological and Cognitive Problems Faced by Survivors of Critical Illness

10.1093/med/9780199398690.003.0001 ◽

2017 ◽

Author(s):

Christina Jones ◽

Peter Gibb ◽

Ramona O. Hopkins

Keyword(s):

Critical Care ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Physical Therapy ◽

Cognitive Impairments ◽

Impaired Memory ◽

Cognitive Problems ◽

Substantial Morbidity ◽

Post Intensive Care Syndrome

Millions of patients are treated in intensive care units (ICUs) each year, and the number of survivors is growing as a result of advances in critical care medicine. Unfortunately, many survivors of critical illness have substantial morbidity. Physical, psychological, and cognitive impairments are particularly common—so much so that a group of clinicians coined the term “post-intensive care syndrome” (PICS) to help raise awareness. Patients surviving critical illnesses are often quite weak, and physical therapy, hopefully starting in the ICU, is vital. But weakness is only one of the problems critical-illness survivors and their loved ones face. Unfortunately, many survivors are left with cognitive impairment (e.g., impaired memory, attention, and executive functioning), as well as distress-related psychiatric phenomena such as posttraumatic stress and depression. Importantly, these problems are not limited to adult patients, and loved ones also suffer. In this chapter the authors describe their personal journeys in coming to understand the suffering and issues that critical-illness survivors and their families face.

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Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Life ◽

10.3390/life12010107 ◽

2022 ◽

Vol 12 (1) ◽

pp. 107

Author(s):

Charikleia S. Vrettou ◽

Vassiliki Mantziou ◽

Alice G. Vassiliou ◽

Stylianos E. Orfanos ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Relevant Literature ◽

Medical Science ◽

Care Community ◽

Physical Problems ◽

Post Intensive Care Syndrome

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization”. A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.

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Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study

PLoS ONE ◽

10.1371/journal.pone.0244564 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0244564

Author(s):

Naoya Yanagi ◽

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Ryota Matsuzawa ◽

Kohei Nozaki ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Physical Disability ◽

Cox Regression ◽

Apache Ii Score ◽

All Cause Mortality ◽

Patient Health ◽

Post Intensive Care Syndrome

Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

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COVID-19 and Post-intensive Care Syndrome: Community-Based Care for ICU Survivors

Home Health Care Management & Practice ◽

10.1177/1084822320974956 ◽

2020 ◽

pp. 108482232097495

Author(s):

Ellen M.T. Smith ◽

Alan Chong W. Lee ◽

James M. Smith ◽

Alecia Thiele ◽

Hallie Zeleznik ◽

...

Keyword(s):

Mental Health ◽

Intensive Care ◽

Critical Illness ◽

Health Care Providers ◽

Mental Health Problems ◽

Screening Tools ◽

Care Providers ◽

Community Based ◽

The Impact ◽

Post Intensive Care Syndrome

Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.

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Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10040614 ◽

2021 ◽

Vol 10 (4) ◽

pp. 614 ◽

Cited By ~ 1

Author(s):

Nobuto Nakanishi ◽

Rie Tsutsumi ◽

Kanako Hara ◽

Masafumi Matsuo ◽

Hiroshi Sakaue ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Muscle Atrophy ◽

Critically Ill Patients ◽

Chronic Illnesses ◽

Rehabilitation Management ◽

Muscle Dystrophy ◽

Thin Filaments ◽

Thick Filaments ◽

Post Intensive Care Syndrome

Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies have reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients’ condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.

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The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative

Journal of the Intensive Care Society ◽

10.1177/1751143720988708 ◽

2021 ◽

pp. 175114372098870

Author(s):

Zudin Puthucheary ◽

Craig Brown ◽

Evelyn Corner ◽

Sarah Wallace ◽

Julie Highfield ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Inpatient Rehabilitation ◽

Service Evaluation ◽

Language Therapy ◽

Initial Development ◽

Related Data ◽

Acute Hospitals ◽

Rehabilitation Needs ◽

Post Intensive Care Syndrome

Background Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result. Methods Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour. Results No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = −1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted. Conclusions The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.

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488: DESCRIBING POST-INTENSIVE CARE SYNDROME IN PEDIATRIC SURVIVORS OF CRITICAL ILLNESS

Critical Care Medicine ◽

10.1097/01.ccm.0000509166.40880.fd ◽

2016 ◽

Vol 44 (12) ◽

pp. 198-198

Author(s):

Christopher Schneller ◽

Briseyda Morales ◽

Laura Campbell ◽

Meredith Bone

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Post Intensive Care Syndrome

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Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study

PLoS ONE ◽

10.1371/journal.pone.0252167 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252167

Author(s):

Takeshi Unoki ◽

Hideaki Sakuramoto ◽

Sakura Uemura ◽

Takahiro Tsujimoto ◽

Takako Yamaguchi ◽

...

Keyword(s):

Mental Health ◽

Intensive Care ◽

Depressive Symptoms ◽

Unplanned Admission ◽

Event Scale ◽

Icu Discharge ◽

One Year ◽

The Impact ◽

Post Intensive Care Syndrome ◽

At Home

Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms.

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