What is Post Intensive Care Syndrome?
PICS, which stands for Post-Intensive Care Syndrome, is a condition that affects the physical, cognitive, and mental functions of critically ill patients both during and after their admission to the ICU. It not only impacts the long-term prognosis of ICU patients but also affects the mental well-being of their families.
There are three main categories of symptoms associated with PICS:
PICS can cause a variety of motor dysfunctions such as impaired pulmonary function, especially after ARDS, neuromuscular disorders, and generalized motor dysfunction including a reduction in muscle mass volume and strength. ICU-acquired weakness (ICU-AW) is the most well-known type of physical dysfunction and presents as a syndrome of diffuse symmetrical muscle weakness in the extremities. Recent studies also indicated that physical dysfunction can be caused by the severity of a critical illness itself through systemic impacts of inflammation and pro-inflammatory cytokines.
Between 30-80% of patients who survive the ICU experience cognitive dysfunction, which can be a risk factor for increased mortality, as well as a significant burden on their families and increased medical costs. Delirium during ICU stay also significantly affects not only short- and long-term prognosis but also long-term cognitive function after survivorship from ICU. Elderly patients are particularly vulnerable to cognitive dysfunction, which may be due to worsening dementia.
Depression, anxiety, and posttraumatic stress disorder (PTSD) are frequently taken as psychiatric components of PICS. Studies have shown that up to 30% of critically ill patients experience depression, 70% experience anxiety, and 10-50% develop PTSD. Anxiety and depression can lead to feelings of sadness, hopelessness, and difficulty concentrating and PTSD can cause symptoms such as flashbacks, nightmares, avoidance behaviors, and hyperarousal. These psychiatric disorders can have significant impacts on the lives of ICU survivors, including decreased quality of life, social isolation, difficulty returning to work or daily activities, and increased healthcare utilization. Therefore, a psychological assessment and interventions at right time should be performed.
In addition to PICS, there is also PICS-F, which affects family members of survivors and non-survivors. PICS-F can cause long-term psychological and social effects, including anxiety disorders, depression, acute stress reactions, sleep disorders, and PTSD. Approximately 10-75% of patients’ families suffer from anxiety. Especially when a patient dies, the family may experience a sense of loss and suffer complicated grief for an extended period of time.
- Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from the intensive care unit: Report from a stakeholders’ conference. Critical Care Medicine. 2012;40(2):502-509.
- Davidson JE, Harvey MA, Schuller J, Black G. Post-intensive care syndrome: What is it and how to help prevent it. American Nurse Today. 2013;8(5):32-38.