Question 25

Discuss Post Intensive Care Syndrome (PICS). Your answer should include the following headings:
a) Definition.    (1 mark)
b) Clinical manifestations.    (3 marks)
c)  Risk factors.    (3 marks)
d) Prevention.    (3 marks)

[Click here to toggle visibility of the answers]

College Answer

Syllabus topic/section:

2.1.16    Populations requiring special considerations in Intensive Care.

Aim:

To explore the common sequalae of the long term critically ill patient.

Discussion:
The question was well answered, and most candidates had a good understanding of Post Intensive Care Syndrome. Some candidates could improve the structure of their answer. It’s important to remember to be specific when describing risk factors. E.g. "length of ICU stay" does not describe the risk, it needs to be quantified for example "increased length of ICU stay".
 

Discussion

a) Definition by the SCCM (Needham et al, 2012):

"new or worsening impairments in physical, cognitive, or mental health status arising after
critical illness and persisting beyond acute care hospitalization"

For this one-mark answer, this would have surely been enough.

b) Clinical manifestations:

  • Physical:
    • Weakness, disuse atrophy
    • Fatigue, reduced exercise tolerance
    • Impairment in activities of daily living
    • Impaired respiratory function, reduced lung volumes and diffusion capacity
  • Cognitive:
    • Impairments in memory, attention, executive function, mental processing speed, visuo-spatial ability
  • Mental:
    • Depression, PTSD, anxiety, sleep disturbance, sexual dysfunction

c) Risk factors:

  • Risk factors for post-ICU physical impairment:
    • Prolonged mechanical ventilation (> 7 days)
    • Sepsis
    • Multisystem organ failure
    • Hyperglycaemia
    • Systemic corticosteroids
    • Age
    • Pre-existing functional impairment
  • Risk factors for post-ICU cognitive impairment:
    • Sedation
    • Hypoxia
    • ICU delirium
    • Pre-exisitng cognitive impairment
  • Risk factors for post-ICU mental illness:
    • Sedation
    • Delirium and agitation
    • Use of physical restraints

d) Prevention:

  • Elimination or correction of causative factors
    • Early extubation
    • Early mobilisation
  • Monitoring for delirium and use of nonpharmacological strategies for its management
    • Using light or minimal sedation
    • Avoidance of physical restraints
  • Reduction or elimination of sources of environmental stress, including
    • Minimising alarms
    • Minimising interruptions to sleep
  • Frequent patient and family communication.

References

Jamjoom, Abdulhakim, et al. "Outcome following surgical evacuation of traumatic intracranial haematomas in the elderly." British journal of neurosurgery 6.1 (1992): 27-32.

Oh's Intensive Care manual: Chapter 8 (pp.61)  Common  problems  after  ICU   by Carl  S  Waldmann  and  Evelyn  Corner

Needham, Dale M., et al. "Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.Critical care medicine 40.2 (2012): 502-509.

Inoue, Shigeaki, et al. "Post‐intensive care syndrome: its pathophysiology, prevention, and future directions." Acute medicine & surgery 6.3 (2019): 233-246.

Rawal, Gautam, Sankalp Yadav, and Raj Kumar. "Post-intensive care syndrome: an overview." Journal of translational internal medicine 5.2 (2017): 90-92.

Kim, Seung-Jun, Kyungsook Park, and Kisook Kim. "Post–intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit." Australian Critical Care 36.4 (2023): 477-484.