The Post-intensive Care Syndrome
Post-intensive care syndrome (PICS) is defined as newly recognized or worsening impairment in one or more of the following domains after critical illness: cognitive function, mental health, and physical function. These impairments frequently persist and c
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Jason H. Maley and Mark E. Mikkelsen
Case Presentation A 60 year-old man with a history of tobacco use and diabetes mellitus was admitted to the hospital with community acquired pneumonia. His course was complicated by hypoxemic respiratory failure requiring 5 days of mechanical ventilation in the Intensive Care Unit (ICU). After 13 days in the hospital, including 5 days of delirium, he was discharged to an acute rehabilitation facility. Upon returning home to live with his wife, he described a frequent fear that his breathing will worsen and that he may have to return to the hospital. He kept a bag of his possessions ready for an emergency return to the hospital. His wife reported that his thinking “isn’t quite the same” as prior to the acute illness. He slept on the first floor as he had difficulty climbing the flight of stairs to his bedroom. He also reported developing depression secondary to his dependence on others’ for his activities of daily living and his inability to return to work as an accountant. Question Which features are characteristic of the Post-Intensive Care Syndrome? Answer The Post-Intensive Care Syndrome (PICS) describes a constellation of symptoms,
J.H. Maley • M.E. Mikkelsen (*) Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA e-mail: [email protected]
which includes impairment in neuropsychological and physical well-being that occurs following an episode of critical illness [1, 2]. This recently recognized entity lies at the core of critical care survivorship. Patients who have experienced shock, respiratory failure, and prolonged sedation and mechanical ventilation are most at risk for development of PICS. Furthermore, pre-existing impairment in one or more of these domains may worsen after critical illness, a fact that warrants obtaining a history that captures physical function, mental health and cognitive function pre-illness. A longitudinal, coordinated effort is required to mitigate the risk of PICS development and rehabilitate new or more severe impairments (Table 32.1).
Principles of Management Diagnosis Survivors of critical illness are at risk for PICS development, and in particular those who experience shock and respiratory failure requiring mechanical ventilation. Risk factors associated with long-term physical and/or neuropsychological impairment include sepsis, acute respiratory distress syndrome (ARDS), multi-system organ failure, prolonged ICU length of stay, duration of delirium, glucose dysregulation, and the use of corticosteroids [2, 5–9].
© Springer International Publishing Switzerland 2017 R.C. Hyzy (ed.), Evidence-Based Critical Care, DOI 10.1007/978-3-319-43341-7_32
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J.H. Maley and M.E. Mikkelsen
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Table 32.1 Post-intensive care syndrome: diagnosis, prevention, and rehabilitation strategies that can be paired with educational efforts to prepare out-patient providers, survivors, and their caregivers about the potential long-term consequences of critical illness Domain Cognition
Diagnosis U
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