Post-intensive care syndrome (PICS): recent updates

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Abstract

An increasing number of patients are surviving critical illness, but some experience new or worsening long-lasting impairments in physical, cognitive and/or mental health, commonly known as post-intensive care syndrome (PICS). The need to better understand and improve PICS has resulted in a growing body of literature exploring its various facets. This narrative review will focus on recent studies evaluating various aspects of PICS, including co-occurrence of specific impairments, subtypes/phenotypes, risk factors/mechanisms, and interventions. In addition, we highlight new aspects of PICS, including long-term fatigue, pain, and unemployment.

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Most cited references 62

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Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

Dale M. Needham, Judy R. Davidson, Henry Cohen … (2012)

Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

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One-year outcomes in survivors of the acute respiratory distress syndrome.

Margaret Herridge, Angela Cheung, Catherine Tansey … (2003)

As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed. We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute-walk test, and a quality-of-life evaluation. Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up. Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent. Copyright 2003 Massachusetts Medical Society

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Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

Kirsi-Maija Kaukonen, Michael Bailey, Satoshi Suzuki … (2014)

Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate. To describe changes in mortality for severe sepsis with and without shock in ICU patients. Retrospective, observational study from 2000 to 2012 including 101,064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand. Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation). Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12,512; P < .001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P < .001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P < .001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P < .001). In the absence of comorbidities and older age, mortality was less than 5%. In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

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Author and article information

Contributors

Stephanie L. Hiser:

ORCID: http://orcid.org/0000-0001-8252-0517

stephanie.hiser@gwu.edu , shiser1@jh.edu

Journal

Journal ID (nlm-ta): J Intensive Care

Journal ID (iso-abbrev): J Intensive Care

Title: Journal of Intensive Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2052-0492

Publication date (Electronic): 23 May 2023

Publication date PMC-release: 23 May 2023

Publication date Collection: 2023

Volume: 11

Electronic Location Identifier: 23

Affiliations

[1 ]GRID grid.253615.6, ISNI 0000 0004 1936 9510, Department of Health, Human Function, and Rehabilitation Sciences, , The George Washington University, ; 2000 Pennsylvania Ave. NW, Suite 2000, Washington, DC 20006 USA

[2 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Physical Medicine and Rehabilitation, , Johns Hopkins University School of Medicine, ; Baltimore, MD USA

[3 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Outcomes After Critical Illness and Surgery (OACIS) Group, , Johns Hopkins University, ; Baltimore, MD USA

[4 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Division of Pulmonary and Critical Care Medicine, Department of Medicine, , Johns Hopkins University School of Medicine, ; Baltimore, MD USA

[5 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, School of Nursing, , Johns Hopkins University, ; Baltimore, MD USA

Author information

Stephanie L. Hiser http://orcid.org/0000-0001-8252-0517

Article

Publisher ID: 670

DOI: 10.1186/s40560-023-00670-7

PMC ID: 10202754

PubMed ID: 37221567

SO-VID: 5dce445f-4857-43fd-be4b-e635921e7089

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 February 2023

Date accepted : 12 May 2023

Post-intensive care syndrome (PICS): recent updates

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Most cited references 62

Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

One-year outcomes in survivors of the acute respiratory distress syndrome.

Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

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