Syndrome Effects of Intensive Therapy – Post Intensive Care Syndrome (PICS)

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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Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Annals of Intensive Care ◽

10.1186/s13613-021-00910-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anne-Françoise Rousseau ◽

Pauline Minguet ◽

Camille Colson ◽

Isabelle Kellens ◽

Sourour Chaabane ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Inpatient Rehabilitation ◽

Quadriceps Strength ◽

Biological Parameters ◽

Icu Stay ◽

Icu Discharge ◽

Prolonged Icu Stay ◽

Post Intensive Care Syndrome

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

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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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The Post-Intensive Care Syndrome in Children

Comprehensive Child and Adolescent Nursing ◽

10.1080/24694193.2018.1520323 ◽

2018 ◽

Vol 43 (1) ◽

pp. 15-21

Author(s):

Ayfer Ekim

Keyword(s):

Intensive Care ◽

Post Intensive Care Syndrome

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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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Post intensive care syndrome across the life course: Looking to the future of paediatric and adult critical care survivorship

Nursing in Critical Care ◽

10.1111/nicc.12605 ◽

2021 ◽

Vol 26 (2) ◽

pp. 64-66

Author(s):

Dylan Flaws ◽

Joseph C. Manning

Keyword(s):

Critical Care ◽

Intensive Care ◽

Life Course ◽

The Future ◽

The Life Course ◽

Post Intensive Care Syndrome

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Post–Intensive Care Syndrome in Family Decision Makers of Long-term Acute Care Hospital Patients

American Journal of Critical Care ◽

10.4037/ajcc2017414 ◽

2017 ◽

Vol 26 (5) ◽

pp. 416-422 ◽

Cited By ~ 3

Author(s):

Amy Petrinec

Keyword(s):

Quality Of Life ◽

Intensive Care ◽

Acute Care ◽

Acute Care Hospitals ◽

Summary Score ◽

Decision Makers ◽

Family Decision ◽

Post Intensive Care Syndrome

Background Family members of critically ill patients experience indications of post–intensive care syndrome, including anxiety, depression, and posttraumatic stress disorder. Despite increased use of long-term acute care hospitals for critically ill patients, little is known about the impact of long-term hospitalization on patients’ family members. Objectives To examine indications of post–intensive care syndrome, coping strategies, and health-related quality of life among family decision makers during and after patients’ long-term hospitalization. Methods A single-center, prospective, longitudinal descriptive study was undertaken of family decision makers of adult patients admitted to long-term acute care hospitals. Indications of post–intensive care syndrome and coping strategies were measured on the day of hospital admission and 30 and 60 days later. Health-related quality of life was measured by using the Short Form-36, version 2, at admission and 60 days later. Results The sample consisted of 30 family decision makers. On admission, 27% reported moderate to severe anxiety, and 20% reported moderate to severe depression. Among the decision makers, 10% met criteria for a provisional diagnosis of posttraumatic stress disorder. At admission, the mean physical summary score for quality of life was 47.8 (SD, 9.91) and the mean mental summary score was 48.00 (SD, 10.28). No significant changes occurred during the study period. Problem-focused coping was the most frequently used coping strategy at all time points. Conclusion Family decision makers of patients in long-term acute care hospitals have a significant prevalence of indications of post–intensive care syndrome.

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The Post-Intensive Care Syndrome

Evidence-Based Critical Care ◽

10.1007/978-3-030-26710-0_109 ◽

2020 ◽

pp. 813-817

Author(s):

Jason H. Maley ◽

Mark E. Mikkelsen

Keyword(s):

Intensive Care ◽

Post Intensive Care Syndrome

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