Post-Intensive Care Syndrome: Causes, Symptoms Treatment, Recovery

What is Post-Intensive Care Syndrome?

It has been observed by one and all that over the past two decades or so the survival rates of critically ill patients have improved. This is mainly due to modern techniques and the advances that critical medicine has made over the years.  However, some of these survivors develop certain psychiatric and physical disabilities after being discharged from the hospital.  This is what is termed as Post-Intensive Care Syndrome [1, 2, 3].

Post-Intensive Care Syndrome is a condition that not much people are aware of and as such is underdiagnosed.  This results in poor quality of life of the patient and cause significant stress in both the patient and the family alike.  A person with Post-Intensive Care Syndrome will display cognitive impairment, decreased overall psychological health, and overall issues with physical function following discharge from the ICU.  This further stresses the family who has already gone through a lot with their close family member being in the ICU for long period of time.  This is termed as PICS-Family [1, 2, 3].

As of recent, with more awareness about this condition, Post-Intensive Care Syndrome has now been recognized as a health burden but the prevalence of this disorder is not well known.  A person with Post-Intensive Care Syndrome will have neuromuscular weakness affecting the muscles and nerves, change in the overall thinking of the person, anxiety, depression, and symptoms of posttraumatic stress disorder [1, 2, 3].

What Causes Post-Intensive Care Syndrome?

A person is referred to critical or intensive care in cases where their medical condition is termed as critical.  Their stay in the ICU puts undue stress on the minds of the patient causing what we define as Post-Intensive Care Syndrome.  The medical condition along with placement of external equipment like mechanical ventilation and feeding tubes further worsen the already stressed out mind of the patient.  Additionally, the sedatives and analgesics that are given during ICU stay also add to the worsening of the symptoms of Post-Intensive Care Syndrome [3].

What are the Symptoms of Post-Intensive Care Syndrome?

A person with Post-Intensive Care Syndrome will have symptoms that can be classified into three categories, namely physical, cognitive, and mental.  An article on Post-Intensive Care Syndrome published in 2019 reveals that the symptoms of this condition may become evident several months after discharge from the ICU.  The symptoms of Post-Intensive Care Syndrome are variable and differ from individual to individual [3].

As an example, people who are mentally and physically strong may not have that much of a problem with Post-Intensive Care Syndrome than some others who may be fragile physically and mentally.  The symptoms of Post-Intensive Care Syndrome include [3]

Physical Symptoms: Some of the physical symptoms that are seen in people with Post-Intensive Care Syndrome include muscle weakness, problems with breathing, unrelenting pain, sexual dysfunction, and muscle atrophy [3].

Cognitive Symptoms: The cognitive symptoms of Post-Intensive Care Syndrome can be seen in about 50% of people discharged from ICU.  The symptoms are variable in that in some people they may fade away rapidly and for some they may linger for a significant period of time.  These symptoms include problems with speech, memory, focus and concentration [3].

There may also be problems with organization of thoughts.  Among all the cognitive symptoms seen in Post-Intensive Care Syndrome, the most serious one is delirium which can have a significant impact on a person.  It may alter the consciousness and attention span of the person [3].

Mental Health Symptoms: This is also seen in between 8-50% of people with Post-Intensive Care Syndrome.  The symptoms include anxiety, depression, and PTSD [3].

How is Post-Intensive Care Syndrome Treated?

Researchers recommend a multidisciplinary approach to treating Post-Intensive Care Syndrome so that all aspects of the condition can be addressed.  It will include a team of critical care physicians, psychiatrists, physical therapists, and respiratory therapists.  For treating the physical symptoms of a person with Post-Intensive Care Syndrome physical therapy, exercises, occupational therapy, and rehab is recommended [3].

For treating the mental aspect of Post-Intensive Care Syndrome, psychotherapy, behavioral therapy, medications in the form of anxiolytics and antidepressants may be prescribed to manage the symptoms.  Cognitive rehabilitation therapy has been found to be quite effective in treating the cognitive aspect of Post-Intensive Care Syndrome [3].

Post-Intensive Care Syndrome affects people in more ways than one.  Thus it is important to follow certain strategies to curtail the symptoms of Post-Intensive Care Syndrome.  First and foremost, it is mandatory for the patient to attend all hospital appointments after being in the ICU.  They need to get checked for the condition that they were admitted for as well as any other condition that may have come up [3].

People with Post-Intensive Care Syndrome should adopt a healthy lifestyle by eating a diet as prescribed by the nutritionist, sleep well, and be as active as possible.  It is also important to keep the mind occupied during recuperation by reading books, solving puzzles, and watching games.  An article published in the Journal of Patient Experience in 2017 mentions that keeping a diary while in the ICU and when out of it helps significantly during the recovery process.  It also helps the family members deal with the patient if he or she tends to have any mental or cognitive changes [3].

What Is The Recovery Time for Post-Intensive Care Syndrome?

Complete recovery from the symptoms of Post-Intensive Care Syndrome depends on the severity of the condition and is quite variable.  While some people tend to get back to normal very quickly others may take years to make a complete recovery. The recovery and prognosis basically depends on three factors, the severity and extent of the original medical condition for which the individual was in ICU, the severity of the symptoms while leaving the ICU and any other preexisting cognitive or mental impairment the individual may have [3].

The time of the symptoms of Post-Intensive Care Syndrome also is quite variable in that some people develop it while in the ICU others may not have any symptoms until months out of it.  A study done in 2018 revealed that about 50% of people who had been admitted to ICU had at least one symptom of Post-Intensive Care Syndrome even after one year from discharge [3].

In conclusion, Post-Intensive Care Syndrome is defined as a collection of physical, cognitive, and mental impairments that a person develops when he is admitted to ICU for a critical illness and discharged after being treated.  The time the individual spends in the ICU is the primary cause of the symptoms.  It not only affects the patient but also the family members [1, 2, 3].

The symptoms may range from muscle weakness, problems with focus and concentration to something as severe as delirium.  The symptoms of Post-Intensive Care Syndrome are quite variable in that some people may recover quite quickly while in others the symptoms may linger for years [1, 2, 3].

Researchers recommend that to prevent any symptoms related to Post-Intensive Care Syndrome sedation should be minimized until absolutely necessary and exercise should be encouraged.  The recovery time is also quite variable studies suggest that some people have at least one symptom, even after one year post discharge, related to Post-Intensive Care Syndrome [1, 2, 3].

References:

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