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Critical care survivors develop cognitive, physical or mental disability after prolonged admission in an intensive care unit.

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PICS is defined as new or worsening impairment in physical (ICU- acquired neuromuscular weakness), cognitive (thinking and judgement) or mental health status arising from critical illness and persisting beyond discharge from acute care setting.            (Needham DM, et al., 2012)

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Refers to the acute and the chronic psychological effects of critical illness among the family members during the critical illness as well after the discharge from ICU.

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Cognitive impairment  Delirium in ICU  Acute brain dysfunction ( Stroke, alcohol) Hypoxia (ARDS, cardiac arrest) Hypotension ( sepsis, trauma) Renal replacement therapy Respiratory failure

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Psychological impairment  Female gender  Use of sedation  Physical impairment  Prolonged mechanical ventilation  Sepsis  MODS  Prolonged duration of sedation

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Female sex Younger relative Patient age Lower educational level Spouse More comorbidities  Mental illness

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Physical impairment  Intensive care unit weakness Classified into critical illness polyneuropathy, critical illness myopathy, critical illness neuromyopathy, muscle deconditioning Incidence of ICU-AW is 40%.

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Cognitive  Manifestation of brain dysfunction  Includes impaired memory, language, attention and visual- spatial abilities. Delirium, dementia and depression  Mental impairment  Depression, anxiety and PTSD

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Psychological impairment
Anxiety
Depression
Sleep disorders
Post-intensive care
syndrome
Cognitive impairment
Memory difficulties
Concentration difficulties
Slowed mental processing
Physical impairment
Weakness and balance problem
Neurmuscular impairment
Breathing problem

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Generalised weakness Fatigue  Decreased mobility  Sexual dysfunction Sleep disturbances Memory disturbances  Poor concentration

Sleep deprivation Anxiety  Depression Complicated grief  PTSD

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Elimination or correction of causative factors Appropriate administration of sedatives Reduction or elimination of environmental stress Frequent patient and family communication

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Maintain ICU diary Post-ICU clinics  Physiotherapy  Occupational therapy  Rehabilitation

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Awakening (use light or minimal sedation) Breathing (spontaneous breathing trials) Coordination of care and communication  Delirium monitoring, assessment and management Early ambulation

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Family and follow-up referrals Good communication  Handout materials

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Implementation of ABCDEFGH Bundle. Sleep hygiene  Family involvement  Providing information Noise reduction devices like ear plugs, headphones  Eye mask  Music therapy  Adequate energy and protein intake

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Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive Care Syndrome: an Overview.  Journal of translational internal medicine ,  5 (2), 90–92.  https://doi.org/10.1515/jtim-2016-0016 Colbenson, G. A., Johnson, A., & Wilson, M. E. (2019). Post-intensive care syndrome: impact, prevention, and management.  Breathe (Sheffield, England) ,  15 (2), 98–101.  https://doi.org/10.1183/20734735.0013-2019 https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome

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Brown, S. M., Bose, S., Banner-Goodspeed, V., Beesley, S. J., Dinglas, V. D., Hopkins, R. O., Jackson, J. C., Mir-Kasimov, M., Needham, D. M., Sevin, C. M., & Addressing Post Intensive Care Syndrome 01 (APICS-01) study team (2019). Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review.  Annals of the American Thoracic Society ,  16 (8), 947–956.  https://doi.org/10.1513/AnnalsATS.201812-913FR

Post intensive care syndrome 

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slide6-hotlink15364

 Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive Care Syndrome: an Overview.  Journal of translational internal medicine ,  5 (2), 90–92.  https://doi.org/10.1515/jtim-2016-0016 Colbenson, G. A., Johnson, A., & Wilson, M. E. (2019). Post-intensive care syndrome: impact, prevention, and management.  Breathe (Sheffield, England) ,  15 (2), 98–101.  https://doi.org/10.1183/20734735.0013-2019 https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome

slide21-hotlink30723

 Brown, S. M., Bose, S., Banner-Goodspeed, V., Beesley, S. J., Dinglas, V. D., Hopkins, R. O., Jackson, J. C., Mir-Kasimov, M., Needham, D. M., Sevin, C. M., & Addressing Post Intensive Care Syndrome 01 (APICS-01) study team (2019). Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review.  Annals of the American Thoracic Society ,  16 (8), 947–956.  https://doi.org/10.1513/AnnalsATS.201812-913FR

Post intensive care syndrome

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