Post-Intensive Care Syndrome (PICS)

Overview

What is post intensive care syndrome (PICS)?

Post-intensive care syndrome (PICS) is a collection of physical, mental and emotional symptoms that continue to persist after a patient leaves the intensive care unit (ICU).

Because of the advances in medicine over the last several decades, more people now survive critical illnesses. Clinicians used to focus more on the immediate short-term outcomes of these patients. More recently, medical professionals have shifted their attention to the long-term outcomes of survivors of critical illnesses. What they discovered is that although ICU survival improved, patients did not return to their former level of function for weeks, months and even years. Patients developed mind, body and emotional symptoms related to their critical illness and treatment in the ICU.

Who gets post-intensive care syndrome (PICS)?

Anyone who survives a critical illness that warranted admission to an intensive care unit (ICU) is susceptible to developing post-intensive care syndrome (PICS).

In addition to the critically ill ICU survivor, the family and loved ones (“the caregivers”) who provide the needed care and support can also develop some of the same mental and emotional symptoms of PICS. This condition is called PICS-family (PICS-F).

PICS impacts the quality of life of both the patient and family.

Symptoms and Causes

What are the symptoms of post-intensive care syndrome (PICS)?

Patients with PICS may have new or worsening brain (cognitive), emotional and/or physical symptoms. The symptoms start after the critical illness, persist after discharge from the ICU and can last for weeks, months and even years.

Brain (cognitive) symptoms:

  • Decreased memory, thinking problems
  • Difficulty talking
  • Forgetfulness
  • Poor concentration
  • Trouble organizing and problem solving

Emotional symptoms:

Physical symptoms:

  • Muscle weakness
  • Fatigue
  • Decreased mobility
  • Difficulty breathing
  • Insomnia

Symptoms of PICS-F in caregivers may include:

  • Anxiety and/or depression
  • Feeling overwhelmed
  • Stress
  • Post-traumatic stress disorder
  • Grief
  • Changes in sleep

What causes post-intensive care syndrome (PICS)?

Post-intensive care syndrome (PICS) results from the combination of factors. Care in the ICU can be intense due to the serious medical conditions themselves (such as respiratory failure, sepsis); use of life-sustaining equipment (such as endotracheal tubes, mechanical ventilators); and use of sedative, pain and other medications that have mind-altering (including delusional) effects. Patient exposure to all of these unique stressors can affect many aspects of the ICU survivor’s life.

Diagnosis and Tests

How is post-intensive care syndrome (PICS) diagnosed?

Physicians use cognitive impairment screening tests to evaluate mental functions. Stress and anxiety disorders and depression can also be assessed with screening questionnaires. Physical weakness due to the prolonged bed rest and illness is easily diagnosed with physical exam and medical history. Pain and delirium are also carefully assessed.

Management and Treatment

How is post-intensive care syndrome (PICS) treated?

The healthcare team will use many approaches to prevent and treat PICS. These include:

  • Using light or minimal sedation.
  • Providing the lowest dose needed to manage pain.
  • Monitoring for and managing delirium.
  • Getting the patient moving as soon as possible in the ICU. Even after the ICU stay, physical therapists and occupational therapists can continue to reduce weakness and improve physical functioning.
  • Recommending pulmonary (lung) or cardiovascular (heart) rehabilitation (if appropriate) due to the high prevalence of respiratory and cardiovascular disease in patients after ICU discharge.
  • Treating depression, anxiety and post traumatic stress disorder with a combination of medications, psychological and behavioral therapies.
  • Avoiding hypoglycemia (low blood sugar levels) and hypoxemia (low oxygen levels).
  • Encouraging the patient and family members to keep an ICU diary.
  • Providing follow-up counseling with a psychologist or psychiatrist for patients with emotional symptoms.
  • Advising the patient to get an adequate amount of sleep and to eat healthy.

How can family members help their loved one with post intensive care syndrome (PICS)?

Family members can help to decrease the effects of PICS by helping their family member stay “oriented” and encouraging exercise, beginning in the ICU.

  • Talk about the current date and time and familiar people, places and current events.
  • Bring in pictures or favorite items from home.
  • Keep an ICU diary to help cope with anxiety, depression and post-traumatic stress disorder.
  • Read stories aloud at the bedside.
  • Participate in activities such as card games or puzzles.
  • Encourage sleep during the night and activity during the day.
  • Ask the health care team to teach you how to help with exercise and bedside care.

How can family members who have post-intensive care syndrome (PICS-F) help themselves?

  • Talk with the health care team about the plan of care.
  • Try to continue a normal daily routine by eating well, getting rest and exercising.
  • Seek support from family or friends.
  • Participate in bedside care.
  • Family members with ongoing emotional symptoms may need to see a professional counselor, psychologist or psychiatrist.

Most hospitals offer social workers, case managers and chaplains to support patients and their families through their critical illness. Ask your healthcare team for more information.

Resources

Society of Critical Care Medicine. Connect with Patients and Families.

Last reviewed by a Cleveland Clinic medical professional on 07/08/2019.

References

  • Golovyan DM, Khan SH, Wang S, Khan BA. 1-Minute Consult: What should I address at follow-up of patients who survive critical illness? (https://www.mdedge.com/ccjm/article/168950/critical-care/what-should-i-address-follow-patients-who-survive-critical-illness) Cleve Clinic J Med 2018;85(7):523-526. Accessed 7/2/2019.
  • Wergin R, Modrykamien A. Cognitive impairment in ICU survivors: Assessment and Therapy. (https://www.mdedge.com/ccjm/article/95671/critical-care/cognitive-impairment-icu-survivors-assessment-and-therapy) Cleve Clinic J Med 2012;79(10):705-712.
  • Society of Critical Care Medicine. Post intensive Care Syndrome. (https://sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome) Accessed 7/2/2019.
  • Rawal G, Yadav S, Kumar R. Post-intensive Care Syndrome: An Overview. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506407/) J Transl Int Med 2017Jun;5(2):90-92. Accessed 7/2/2019.
  • Bautista CA, Nydahl P, Bader MK, et al. Executive Summary: Post-Intensive Care Syndrome in the Neurocritical Intensive Care Unit. J Neurosci Nurs 2019;51(4):158-161. Accessed 7/2/2019.
  • Needham, DM, Davidson, J, Cohen, H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012;40(2): 502-509. Accessed 7/2/2019.

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