Post-Intensive Care Syndrome: From Diagnosis To Treatment.

Abstract

Patients who have been treated in intensive care units (ICUs) display a multitude of physical, cognitive, and/or mental impairments that are collectively called post-intensive care syndrome (PICS). People with PICS have difficulty returning to everyday life. In this narrative review, we present epidemiologic data, risk factors, and approaches to the prevention and treatment of PICS, along with the evidence supporting them. Preliminary findings on the prevalence of PICS and the frequency of treatment for it have been obtained at the PICS outpatient clinic at the Charité-Universitätsmedizin Berlin, where patients are evaluated three months after discharge from an ICU along the three domains of PICS: physical function, cognitive performance, and mental health. These findings yield an overall picture of the everyday reality of post-ICU patient care. Knowledge of the predisposing factors for PICS (sex, old age, pre-existing mental disorders) and of its precipitating factors (stressful experiences in the ICU, severity of illness, delirium), which may change over the course of treatment, enables clinicians to identify patients at risk of PICS and to pursue preventive strategies while they are still being treated in the ICU. Specialized aftercare consists of a wide variety of multidisciplinary treatments whose efficacy remains to be conclusively demonstrated. These include guidance by a physician, patient education, physiotherapy, psychosocial care, and self-help groups. According to the initial findings of the PICS outpatient clinic at the Charité, Campus Virchow Klinikum, 72% (298/417) of patients suffer from impairment in at least one PICS domain three months after discharge from an ICU. The analysis of treatment frequency revealed that half of all patients visited the PICS outpatient clinic in addition to their family physician's practice in at least two three-month periods after their ICU discharge. The specialized, multiprofessional care of patients who have been discharged from an ICU, and of their family members, requires an understanding of the complex pertinent risk factors and courses of illness. It would be desirable for cross-sector care strategies to be established with better integration of rehabilitative services, specialized aftercare facilities, nursing facilities, and primary care practices.