Post-Intensive Care Syndrome and Chronic Critical Illness: A Tale of Two Syndromes

Abstract

Survivors of critical illness face a variety of challenges during convalescence. One such challenge is termed the post-intensive care syndrome (PICS). PICS is defined by disordered cognition, persistent weakness, distorted psychosocial functioning, and may also impact family members (PICS-F). Current efforts to reduce the incidence of PICS include bundled approaches to care that appear to reduce ventilator and ICU length of stay, delirium, and coma while enhancing survival. These interventions are supported by an ICU diary, and engaging family members in rounds, shared decision-making, and supportive care. Management approaches after discharge include structured physical rehabilitation, post-ICU clinics, and peer support groups. An important and vulnerable subset of PICS patients demonstrates chronic critical illness. This subgroup is defined by a more than 14-day ICU stay accompanied by persistent inflammation, infection, and catabolism as well as organ failure. The elderly with malnutrition may be a unique set of patients with chronic critical illness. Survivors of chronic critical illness are likely overrepresented in the PICS population and represent an ideal target group for intervention. New and persistent comorbidity, increased financial expenditure, and decreased independence may all reinforce the key elements of PICS. This constellation of findings further degrades outcomes in a group whose triumph in a high-intensity care center may not match their trajectory upon repatriation home after surviving critical illness as an inpatient. Routine screening for PICS may enhance outcomes by directing patients—and their family members—into focused care paths.