Post-Intensive Care Syndrome (PICS)

Post-intensive care syndrome (PICS) is a collection of symptoms that linger when you go home after receiving treatment in the intensive care unit (ICU). These symptoms may be:

• Emotional
• Mental
• Physical

Being in the ICU is serious. If you need ICU care, it’s because you have a life-threatening injury or illness. But because of advances in medicine over the last several decades, more people now survive critical conditions.

Healthcare providers used to focus more on the immediate short-term results of people who needed ICU care. That is, making sure they survived. More recently, providers have shifted their attention to the long-term outcomes. That means:

• Making sure people who need ICU care can regain their physical abilities
• Ensuring there’s nothing wrong with their mental abilities
• Helping them have a good quality of life

Providers learned that, although more people survived stays in the ICU, they didn’t make a full recovery for a long time. Sometimes, it could take weeks, months or even years. As a result, they developed emotional, mental and physical symptoms that related to their critical condition and treatment in the ICU.

PICS is a common. About 5 to 8 out of every 10 people who receive ICU treatment develop PICS.

What is PICS-F?

Family members or close friends who witness someone receiving ICU care can also develop the mental and emotional symptoms of PICS. This is post-intensive care syndrome-family (PICS-F).

What are the symptoms of post-ICU syndrome?

Post-intensive care syndrome causes new or worsening symptoms that can affect you emotionally, mentally and physically.

Emotional PICS symptoms may include:

• Anxiety
• Decreased motivation
• Depression
• Post-traumatic stress disorder (PTSD), including nightmares and unwanted memories

Mental (cognitive) PICS symptoms may include:

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

Physical PICS symptoms may include:

• Feeling very tired (fatigue)
• Muscle weakness
• Problems falling asleep or staying asleep (insomnia)
• Shortness of breath (dyspnea)
• Trouble moving around (decreased mobility)

Symptoms of post-intensive care syndrome-family may include:

• Anxiety
• Depression
• Grief
• Insomnia
• PTSD
• Stress

Post-intensive care syndrome causes

The ICU can be a very stressful environment. You may experience many different stressors that combine to cause PICS. These may include:

• Medical conditions themselves, for example, respiratory failure or sepsis
• Medications that have mind-altering effects
• The use of life-sustaining equipment, like tubes that go down your throat (endotracheal tubes) or mechanical ventilators

Risk factors

Anyone who survives a critical condition that required ICU care may develop PICS. Family and loved ones who provide care and support to someone who required ICU care can develop PICS-family.

How doctors diagnose PICS

Healthcare providers will review your medical history, ask about your symptoms and conduct a physical exam. They’ll also recommend different tests and questionnaires to help diagnose PICS. These may include:

• Cognitive tests to check your mental functioning
• Screening questionnaires to assess anxiety disorders and depression

How is it treated?

There are many PICS treatments. They may be different depending on why you needed ICU care and what symptoms you have. They may include:

• Antidepressant medications or anti-anxiety medications like benzodiazepines or beta-blockers
• Avoiding low blood sugar levels (hypoglycemia) and low oxygen levels (hypoxemia)
• Getting you moving as soon as possible to reduce weakness and improve muscle function
• Occupational therapy to help perform daily tasks
• Pain medications (analgesics)
• Pulmonary (lung) rehab or cardiac (heart) rehab, if necessary
• Sedatives to help treat anxiety and insomnia
• Talk therapy (psychotherapy) with a psychologist or a psychiatrist

In addition, getting lots of sleep and eating healthy foods can also help your body recover. And keeping a journal about your experiences can help you process your thoughts and feelings.

How can family members help their loved one with PICS?

Friends and family members can help decrease the effects of PICS in loved ones by:

• Bringing in pictures or favorite items from home to their hospital room
• Encouraging a balance between rest and activity
• Participating in activities like card games or puzzles
• Reading the news or stories aloud at their bedside
• Talking about the current date and time and familiar people, places and current events

How can I help myself if I have PICS-F?

PICS-F treatment may include:

• Participating in bedside care
• Recording your thoughts and feelings in a journal
• Seeking support from family or close friends
• Talking to a counselor or therapist
• Talking to your loved one’s healthcare team about their care plan
• Trying to maintain your typical routine, including eating healthy foods, resting and physical activity

Most hospitals also offer social workers, case managers and religious or spiritual services to help provide support to those who need ICU care and their families.

How do you recover from post-ICU syndrome?

Your body is unique, and how it responds to a stay in the ICU may be different from others. Some people don’t have any PICS symptoms. Or they may have a combination of different mental, emotional and physical symptoms. Your care team may include many different specialists. A healthcare provider will give you an idea of what to expect during your recovery based on your specific symptoms.

When should I see my healthcare provider?

It’s important to schedule regular appointments with your healthcare team after a traumatic event. If you or a loved one experiences symptoms of post-intensive care syndrome, contact a provider for an evaluation.

During your appointment, you may wish to ask the following questions:

• Which tests will you conduct to diagnose PICS?
• Are there any other symptoms I should look out for?
• What treatments do you recommend?
• Are there any side effects to your recommended treatments?
• How long do you expect my symptoms to last?
• Can my symptoms come back later?
• Are there any PICS or PICS-F resources or support groups you can recommend?

How long does post-intensive care syndrome last?

It depends. Some people don’t have any symptoms of PICS. But others may have symptoms for a long time. A healthcare provider will give you a better idea of what to expect depending on your situation.

How do you prevent post-ICU syndrome?

Healthcare providers will do their best to help prevent PICS during hospitalization. This may include things like:

• Asking about PICS symptoms during follow-up appointments
• Having you spend only the necessary amount of time on life support machines
• Starting physical therapy, even during other treatments
• Using light or minimal sedation

It’s also important for friends and family members to help with their loved one’s care and recovery.

What is post-ICU delirium?

Post-ICU delirium is a type of confusion that develops after receiving ICU care. It affects your ability to focus your attention and your awareness.