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KEY POINTS
The number of patients who survive acute critical illness has increased over the last few years and PICS is more common than previously thought.
PICS is new or worsening impairment in physical, mental, or cognitive status arising after critical illness and persisting beyond the acute care hospitalization.
These impairments are frequently under recognized and adversely impact daily functioning and the quality of life.
Decline in lung function parameters and ICU-acquired weakness are some of the physical impairments that can affect health care resource utilization and short- and long-term outcomes.
Neurocognitive impairment spans a wide range of dysfunction and is associated with metabolic abnormalities, hypoxemia, fever, sepsis, pharmacological agents, organ dysfunction, and disrupted sleep.
The neuro-psychological impairment encountered after ICU care (eg, anxiety, depression, and PTSD) is not associated with an increased severity of illness but rather to both the subjective and objective aspects of the ICU experience.
Strategies to minimize or prevent PICS should start during the ICU stay and address those modifiable risk factors known to be associated with the different aspects of PICS (eg, glycemic control, minimizing sedation, early exercise and mobilization, liberation from mechanical ventilation).
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Over the past decade, survival from critical illness has dramatically increased due to a better understanding of the pathophysiological mechanisms of disease, improved treatment strategies and advancements in medical technology. Several studies have shown improved survival and long-term outcomes in survivors of critically illness. However, surviving the intensive care unit (ICU) stay is just the start of a long road to recovery for a majority of these patients. The discharge from the ICU opens the path to a long journey of challenging physical rehabilitation, mood disorders, cognitive impairment, psychological distress, financial hardship, and caregiver burden and burnout.
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In recent years there has been a growing recognition of impairments that affect the physical, psychological, social, and emotional aspects of the individual after ICU discharge that may adversely impact daily functioning and quality of life (QOL). Recently, the term “post-intensive care syndrome” (PICS) is used to describe any new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond the acute care hospitalization.1 PICS may persist for months to years after hospital discharge. Most impairments will diminish with time but some may linger on until the patient’s actual demise. This chapter will explore in detail the different domains affected in PICS, its impact on the individual and society, and offer insights into future developments.
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Probably the most obvious and readily recognizable changes in patients immediately after discharge from the ICU are the physical impairments that are the result of the actual critical illness or the direct or indirect side-effects of interventions to treat the disease. An individual patient may lie at a particular point in the spectrum of physical disability according to the patient’s age, ...