Living after New Normal with PICS

Living after New Normal with PICS

Post-Intensive Care Syndrome (PICS) is a common condition that affects patients who have survived a critical illness and have been discharged from the intensive care unit (ICU). It is estimated that up to 80% of ICU survivors will experience some form of PICS.

PICS can manifest a wide range of physical, cognitive, and psychological symptoms. Physical symptoms can include muscle weakness, fatigue, and difficulty sleeping. Cognitive symptoms can include memory problems, difficulty concentrating, and confusion. Psychological symptoms can include depression, anxiety, and post-traumatic stress disorder (PTSD).

One of the main contributors to PICS is the prolonged exposure to critical illness, invasive treatments, and sedative medications that are commonly used in the ICU. These treatments can lead to muscle atrophy, delirium, and other complications that can persist even after the patient has been discharged from the ICU.

Muscle weakness is a common physical symptom of PICS, which is caused by the prolonged use of sedative medications, inactivity, and resulting muscle atrophy. This weakness can persist for months after the patient has left the ICU, making it difficult for them to carry out basic activities of daily living, such as walking and getting dressed.

Cognitive symptoms of PICS can be particularly distressing for patients and their families. Memory problems and difficulty concentrating can make it difficult for patients to return to work or resume their normal activities. Patients may also experience confusion, which can lead to disorientation and a loss of sense of time.

Psychological symptoms of PICS can be equally debilitating, with depression, anxiety, and PTSD being common among ICU survivors. Patients may experience a range of emotions, from fear and anger to guilt and helplessness. These psychological symptoms can have a significant impact on the patient’s quality of life and their ability to return to normal activities.

There are a number of interventions that can be used to address PICS. Physical therapy can be used to help patients rebuild muscle strength and regain their mobility. Cognitive therapy can help patients address memory problems and improve their ability to concentrate. Psychological interventions, such as counseling and cognitive-behavioral therapy, can be used to address the emotional toll of PICS.

Hospitals and healthcare providers can play a role in preventing PICS by implementing protocols to minimize the use of sedative medications, promote early mobilization, and provide appropriate psychological support.

The prevalence of PICS after COVID-19 is 75% based on the literature available in Google Scholar, PubMed, and ScienceDirect databases for English articles published until august 2021. According to reviewed articles impairment of cognitive functions persist months to years after hospital discharge and is associated with poor daily functioning and reduced QOL.

Mental health impairment includes depression, PTSD, etc and physical impairment includes persistent dyspnea and weakness. PICS is assessed by 6 min walk test, functional independence measure, MMSE, Mini cognitive test, short memory questionnaire, etc.

It is imperative that patients with PICS are managed with the goal of long-term health, wellness, and function. PICS is mainly treated by treating its symptoms such as hypoxia, anxiety, etc.

In conclusion, PICS is a common condition that affects ICU survivors and can have a significant impact on their quality of life. It is important that patients, their families, and healthcare providers are aware of the risk of PICS and are prepared to address them during and after the ICU stay. With appropriate interventions, patients can recover from PICS and return to their normal activities.

Written By:
Dr. Neha Reyalch
Assistant Professor
Faculty of Physiotherapy
SGT University

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