Post-intensive care syndrome (PICS)

Post-intensive care syndrome (PICS) is an extremely under recognised entity due to reasons as they usually happen outside of walls of ICU. It is defined as as new or worsening symptoms in three categories after a critical illness.

•  cognitive, or/and
•  psychiatric, or/and 
•  physical function 

Upto 50% of ICU discharged patients may suffer from some degree of PICS. Level of sickness is the biggest indicator particularly delirium, sepsis, ARDS, use of mechanical ventilation etc. It requires proper follow up and diagnostic evaluation. It may persist up to years and has been found to be associated with social and financial morbidities as well as increased risk of death.

Prevention is the best treatment by sedation and neuro-muscular blockade (if use) holidays and most importantly by early physical mobilization in ICU.

Another associated entity is  PICS-F (Post-intensive care syndrome -Family) in loved ones with sleep deprivation, depression, and PTSD. The best strategy to help out is the open and detailed communication.

References:

1. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40:502 

2.  Needham DM, Dinglas VD, Morris PE, et al. Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med 2013; 188:567.  

3.. Jackson JC, Pandharipande PP, Girard TD, et al. Depression, post-traumatic stress disorder, and functional disability in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2014; 5:369. 

4. Hermans G, Van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014; 190:410.