Post-intensive care syndrome (PICS) refers to a group of health impairments that can occur after a person survives a life threatening condition. It can cause physical, cognitive, and mental health conditions.
This article will look at why PICS develops, how people can minimize its impact, and why it is essential to seek support after spending time in an intensive care unit (ICU).
According to a 2013 article in the Journal of Translational Internal Medicine, healthcare professionals define PICS as a worsening of or new impairment in a person’s:
- Physical health: PICS causes neuromuscular weakness, which can affect the nerves and muscles.
- Cognitive health: This refers to changes in how a person thinks and uses their judgment.
- Mental health: A person may experience anxiety, depression, and post-traumatic stress disorder (PTSD).
It can also have knock-on effects on the mental health of family members and other loved ones. When it affects family members, it is called PICS-Family (PICS-F).
Symptoms come under three main categories: physical, cognitive, and mental.
A 2019 article notes that the symptoms of PICS can be subtle and sometimes only appear months after the person has left the ICU.
The prevalence of different symptoms varies among individuals. For some people, PICS has little impact, while others may experience problems in numerous areas.
The following sections will look at each symptom category in more detail.
Physical symptoms that develop from PICS affect around 25–80% of people who have received treatment in an ICU.
As well as new muscle weakness, people may experience the following symptoms:
- breathing difficulties
- sexual dysfunction
- lung impairment
- muscle atrophy
The 2019 article above also states that cognitive impairment affects around 30–80% of people who come out of an ICU.
The effects vary in severity, depending on the individual. They may pass quickly, but they often last for years.
Cognitive symptoms can affect:
- organization of thoughts
The most severe outcome of cognitive issues is delirium, which alters a person’s consciousness and affects their attention. The duration and frequency of delirium will influence the impact it has on a person.
Mental health symptoms
Mental health conditions occur in around 8–57% of people with PICS. Among other conditions, this may take the form of:
People receive intensive care when they are in a critical condition. This puts them under mental and physical stresses, which can result in the development of PICS.
The body needs to recover from the original condition alongside the treatment the person receives in an ICU.
For instance, life sustaining equipment — such as feeding tubes and mechanical ventilators — will put strain on the throat and lungs, according to the National Heart, Blood, and Blood Institute.
Also, sedatives and analgesic medications can increase the risk of experiencing cognitive symptoms of PICS.
Studies suggest that the treatment strategies for PICS use multidisciplinary approaches to tackle all aspects of the syndrome.
The healthcare professionals a person with PICS may come across include:
- critical care physicians
- respiratory therapists
To treat the physical symptoms of PICS, a person can try the following:
- physical therapy
- occupational therapy
To treat the mental symptoms of PICS, a person can try:
- behavioral therapy
- psychological therapy
- medications, such as antidepressants
Cognitive rehabilitation therapy (CRT) can help treat the cognitive symptoms of PICS. CRT is a broad term that covers a wide range of treatments.
Specific symptoms, such as lung impairment, may arise from the use of a mechanical ventilator. Therefore, these symptoms may require specific treatment.
PICS can affect people in different ways. Because of this, ways of managing symptoms will differ among individuals. However, there are some basic management strategies that can help a person during recovery.
Firstly, it is important not to miss hospital appointments after spending time in an ICU. As well as checking up on the original condition, healthcare professionals will be checking to make sure that nothing else is wrong.
To help themselves, people can try managing their general well-being by:
- adopting healthful sleeping habits
- eating a healthful diet
- staying as physically active as possible
- keeping their mind occupied
A 2017 article in the Journal of Patient Experience notes that it can help to keep a diary, both while in the ICU and during recovery. This can also help loved ones deal with any mental challenges that may occur.
Support groups and resources
It can also help to attend support groups, where there is a chance to share experiences with other people in a similar situation.
There are a wide range of support groups and resources available for people who come out of an ICU. It is always a good idea to seek support, even if it feels unnecessary at the time.
Support groups may be led by:
- local authorities
- health or social care initiatives
Other forms of support include one-to-one sessions with healthcare professionals and meetings with others who are going through a similar experience.
People can ask hospital staff if they have any specific recommendations for further support when leaving the ICU.
Recovery times and the severity of symptoms vary widely among individuals. The outlook for PICS mostly depends on three factors:
- how severe the critical illness was
- how severe the impairments are when the person leaves the ICU
- any preexisting factors
A 2013 article notes that the symptoms may only last a few months, but they may also last for many years.
The time at which they first appear also varies. For example, a person may develop problems during their time in ICU, or the symptoms may appear after recovery from the critical illness.
A 2018 study suggests that 56% of people who went into an ICU still had at least one PICS-related symptom a year later.
One prevention strategy is to minimize sedation, which can affect all three major symptom categories of PICS.
Healthcare professionals will also encourage people to get up and moving as soon as possible when they start to recover.
Facilities may use the “A, B, C, D, E, F” approach to prevent symptoms after a person spends time in an ICU. What each letter stands for varies slightly among facilities, but the principles are the same.
One example of this approach is as follows:
- Awakening: A healthcare professional may reduce sedation or use light to wake the person.
- Breathing: They may also use regular spontaneous breathing trials, during which they temporarily remove the person from mechanical ventilation to see how they respond.
- Care coordination: Healthcare professionals will coordinate the different elements of healthcare to make sure that the delivery of treatment is suitable for the individual.
- Delirium: They will also monitor any mental confusion and manage it appropriately.
- Early exercise: Hospital staff will aim to get people mobile and walking without assistance from early on.
- Family engagement: Having family and loved ones present can empower and encourage a person, which can help them recover faster.
PICS affects the person who has had a critical illness, but it also affects the people around them as they help them through recovery.
Strain can be both mental and financial, as only one-third of people with PICS return to their original job or a job with at least their original salary.
According to one 2020 article, the effect on family members is called PICS-F. Studies suggest that around 75% of family members of people in an ICU experience some form of PICS-F, with a third of family members seeking help to manage their own mental health.
The most common conditions that family members with PICS-F experience include:
- sleep deprivation
- complicated grief
Due to the variation in symptoms and overlap with other disorders, PICS can be challenging to diagnose. Different healthcare professionals may diagnose it in different ways.
For example, some use differential diagnosis to assess PICS. They will take a person’s medical history, conduct a physical exam, and initiate laboratory testing to help narrow down the possible causes.
Each symptom has a spectrum of causes, and where those lists overlap can help the healthcare professional make a diagnosis.
Vanderbilt University in Nashville, TN, developed a method that can assess each of the main impairments that come with PICS. This method uses the following tests to identify the presence of the syndrome:
- spirometry, to check how well the lungs are working
- a 6-minute walk test, to assess the person’s physical capability
- mental health screening
- cognitive assessment
PICS is a group of health impairments that affect those who have survived a life threatening condition.
It causes physical symptoms, cognitive impairment, and mental health conditions. It can also affect family members and loved ones. When this occurs, it is called PICS-F.
Hospital staff will try to minimize sedation and encourage early exercise to help prevent the development of PICS.
Treatment involves a variety of approaches, including physical therapy to help treat physical symptoms. Healthcare professionals may also recommend different types of therapy to help treat any mental health symptoms.