Post-Intensive Care Syndrome

Background

Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are termed post-intensive care syndrome (PICS). The objective of this work is to develop a multidisciplinary and professional guide for the rehabilitative therapy of PICS.

Methods

A multidisciplinary/professional working group of 15 healthcare professionals applied a structured evidence-based approach to address 10 scientific questions. For each PICO question (Population, Intervention, Comparison and Outcome), the best available evidence was identified. Recommendations were rated as “strong recommendation,” “recommendation,” or “therapy option,” based on the principles of recommendation classification, assessment, development, and evaluation. Additionally, gaps in the evidence were identified.

Results

The evidence resulted in 12 recommendations, 4 therapy options, and a statement for the prevention or treatment of PICS.

Recommendations:

Early mobilization, motor training, and nutrition/dysphagia management should be performed.
Delirium prophylaxis focuses on behavioral interventions.
ICU diaries can prevent/treat psychological health problems such as anxiety and post-traumatic stress disorders.
Early rehabilitation approaches are recommended, as well as long-term access to specialized rehabilitation centers.
Therapy options include additional physical rehabilitation interventions.

Statement : A prerequisite for the treatment of PICS is periodic and repeated assessments of physical, cognitive, and psychological health in patients at risk for PICS or with PICS.

Conclusions

PICS is a variable and complex syndrome that requires an individual multidisciplinary and multiprofessional approach. PICS rehabilitation should include assessment and therapy of motor, cognitive, and psychological health impairments.

Key points

It is important to evaluate the physical, cognitive, and psychological health functions of critically ill patients at risk of developing post-intensive care syndrome (PICS) during their ICU stay, acute inpatient and outpatient care, and rehabilitation.
Physical health and motor function can be improved through early mobilization, physical therapy, additional ergometer (cycling) training, and neuromuscular stimulation.
Before initiating oral nutrition, a standardized swallow test should rule out risks of dysphagia and aspiration.
Psychological health can be improved by integrating family members into care, maintaining ICU diaries, and providing psychological care.
Cognitive health may improve with delirium prevention, early multimodal delirium treatment, and/or attention training.
Health professionals must be sensitized and trained to recognize PICS.

Conclusions

Appropriate rehabilitation therapy for patients with PICS remains a major challenge in routine clinical practice. An individualized, multimodal, and interdisciplinary approach to rehabilitation therapy, repetitive assessments of physical, psychological, and cognitive health functions, and adherence to evidence-based guidance may be key to improving patient outcomes, which can demonstrate future outcomes studies. As new evidence becomes available, this guidance should be updated accordingly.

* Access the full text of the guide in English here .

Post-Intensive Care Syndrome

A new guide provides practical recommendations for managing post-intensive care syndrome, a constellation of physical, psychological, and cognitive symptoms that can occur in patients following discharge from the intensive care unit.