Post-intensive Care Syndrome Research Articles

Psychosocial Care in the Intensive Care Unit

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.

The feasibility and acceptability of a physician-led ICU follow-up service: A prospective cohort study

BackgroundIncreased recognition of post–intensive care syndrome has led to widespread development of intensive care follow-up services internationally. ObjectiveThe objective of this study was to determine the feasibility and acceptability of an intensive care unit (ICU) follow-up clinic in Australia for patients and their caregivers and to describe satisfaction with this service. MethodsThis was a prospective cohort study in a mixed tertiary ICU in Australia. Eligible patients were adults admitted to the ICU for 7 days or more and/or ventilated for 48 h or more, as well as their primary caregiver. Patients and their primary caregivers were invited to attend a follow-up clinic 4–8 weeks after hospital discharge. The clinic appointment was attended by an ICU physician and nurse, with multidisciplinary support. Feasibility and acceptability were defined as the proportion of clinic attendance and frequency of interventions initiated at the clinic. Satisfaction was measured by a 5-point satisfaction survey (very dissatisfied to very satisfied). The burden of ongoing disease was reported via multiple validated instruments. ResultsFrom April 2020–July 2021, 386 patients met the inclusion criteria. Only 146 patients were approached for consent due to site staffing limitations. Eighty-three patients and 32 caregivers consented to attend the clinic. Seventy percent (54/77) of patients attended scheduled appointments and 50% (16/32) of caregivers. For patients, 23 medical referrals were made, 8 patients had medication changes, and 10 patients were offered social work support. Satisfaction surveys were completed by 65% (35/54) of attending patients; 97% (34) patients reported either being ‘very satisfied’ or ‘satisfied’ with the service. All responding caregivers (10) were either ‘very satisfied’ or ‘satisfied’ with the clinic. ConclusionThere were a large number of patients meeting the inclusion criteria to the ICU follow-up clinic, and clinic attendance was moderate for patients but lower for caregivers. Reported satisfaction with the service was high for both patients and their caregiver.

Mitigating Post-Intensive Care Syndrome: Time to Consider Embedded Pediatric Psychologists in PICUs.

Mitigating Post-Intensive Care Syndrome: Time to Consider Embedded Pediatric Psychologists in PICUs.

Comparison of Post-Intensive Care Syndrome between Patients with and without COVID-19 who had Non-Invasive Mechanical Ventilation Support in the Intensive Care Unit

Comparison of Post-Intensive Care Syndrome between Patients with and without COVID-19 who had Non-Invasive Mechanical Ventilation Support in the Intensive Care Unit

Multiple factors contributing to dysphagia : Extended tasks for the interprofessional team in the intensive care unit

Astay in the intensive care unit (ICU) can be associated with complications and lead to secondary problems, known as post intensive care syndrome (PICS). They can prolong inpatient stays, increase ICU mortality and lead to long-term problems. Onesecondarily acquired problem in intensive care is dysphagia. This article highlights various influencing factors on dysphagia. Some require an extended interprofessional treatment concept that goes beyond strictly speech and swallowing therapist treatment.

Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study

BackgroundThe assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors.MethodsWe conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1–3), important, but not critical (4–6), and critical (7–9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important.ResultsIn total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R.ConclusionBased on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.

Abstract 18115: A Multidisciplinary Approach to Critical Cardiac Illness Survivorship: Cardiac Intensive Care Unit Recovery Clinic

Introduction: Cardiac intensive care unit (CICU) survivors have a high burden of morbidity and debility. Patients discharged from the CICU with a diagnosis of cardiogenic or septic shock, coma after cardiac arrest, or receive mechanical ventilation or mechanical circulatory support are referred by the CICU team to the Cardiac Intensive Care Unit Recovery Clinic (CICURC), a multidisciplinary clinic aimed at identifying barriers to return to function and optimizing medical and rehabilitation therapies. Aims: To define the cardiac profile and symptom burden of CICURC patients and compare outcomes to those referred but never attended. Methods: The medical records of sequential patients referred to the CICURC at our institution were retrospectively reviewed for clinical and outcome variables. Surveys were used to assess for cognitive, physical, or mental health impairment, findings of post-intensive care syndrome (PICS). Chi-squared test was performed to compare outcomes between groups. Results: From CICURC opening July 1, 2022, through May 27, 2023, 27 patients were referred, of whom 15 (56%) were seen in CICURC. The median age of patients seen in clinic was 61 years (IQR 47-74), 14 (93%) were male, 11 (73%) had an out-of-hospital cardiac arrest, 9 (60%) recovered from cardiogenic shock, of whom 5 (33%) were on mechanical circulatory support, and 12 received mechanical ventilation (80%). The median EF was 40% (IQR 25-50). From surveys, 5 patients screened positive for PICS (33%) and 6 were at risk for malnutrition (43%). Compared to those who did not attend clinic, only 1 (7%) CICURC attendee was readmitted within 30 days (vs. 3 [25%], p=0.18) and later died (vs. 4 [40%], p=0.04). Conclusions: CICU survivors have a high burden of disability after discharge. Multidisciplinary clinics focused on CICU recovery may reduce 30-day readmissions and mortality. Further research is needed on diagnosing PICS and therapies for recovery from critical cardiac illness.

Nutritional support and prevention of post-intensive care syndrome: the Italian SIAARTI survey

BackgroundMalnutrition and muscle wasting are common in ICU patients and predict adverse patient-centered outcomes. The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) conducted a nationwide survey to identify the nutritional practices in the Italian ICUs and to plan future, training interventions to improve the national clinical practice.MethodsNationwide online survey, involving Italian ICUs, developed by experts affiliated with SIAARTI. Invitations to participate were distributed through emails and social networks. Data were collected over a period of three months (October 1 to December 31, 2022) during 2022.ResultsOne hundred full responses from participating ICUs were collected. The number of beds is < 10 in most ICUs and > 20 in 11 ICUs. Most ICUs (87%) are mixed, cardiac (5%), neurosurgical (4%), or pediatric ICUs (1%). Although the nutritional program is widely prescribed based on the patients’ general evaluation, 52 ICUs (52%) do not perform nutritional risk evaluation at admission in case of > 24-h stay. Daily caloric intake is mainly based on the 25 kcal/kg equation; otherwise, the Harris-Benedict formula is mostly used, whereas indirect calorimetry is less used. Most clinicians apply a personalized nutritional approach to organ failure. Most ICUs have a nutritional management protocol, and enteral nutrition (EN) is frequently started within 2 days from admission, while supplemental parenteral nutrition is used when EN is insufficient by most clinicians. The EN administered seems to correspond to that prescribed, but it is stopped if the gastric residual gastric is > 300–500 ml in most ICUs.ConclusionPrescription, route, and mode of administration of nutritional support seem to be in line with international recommendations, while suggestions on the tools for assessing the nutritional risk and monitoring efficacy and complications seem far less followed. Future national clinical studies are necessary to investigate the optimal nutritional and metabolic management of critically ill patients and the correspondence with the results of this survey on actual practices.

Post Intensive Care Syndrome in Swiss Paediatric survivors and their Families (PICSS-PF): a national, multicentre, longitudinal study protocol

IntroductionPaediatric intensive care units (PICUs) survivors and their families often experience widespread morbidity and psychosocial consequences after discharge, known as post-intensive care syndrome in paediatrics (PICS-p). In Switzerland, more than...

Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial

BackgroundICU survivors often suffer from prolonged physical and mental impairments resulting in the so called “Post-Intensive Care Syndrome” (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care.MethodsThis pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT’s primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire.ResultsThe pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median).ConclusionThe participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic.Trial registrationClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468

Mental Health in Women.

Mental health illness has been increasing worldwide. The prevalence of mental illness and is higher among females than among males. It is estimated that one in 5 women experience a common mental health disorder. This article highlights gender disparities in the risk, prevalence, and presentation of different mental health disorders. Nearly all survivors of critical illness experience 1 or more domains of the post-intensive care syndrome. We review different mental health disorders including anxiety disorders, mood disorders, psychotic disorders, and post-intensive care syndrome, and medications used to manage these disorders. Delirium in the intensive care unit can be misdiagnosed as a primary psychiatric disorder and is important to distinguish from each other. We also highlight the inadequacy of surveillance and recognition of mental health disorders in the intensive care unit, leading to missed opportunities to properly manage these important psychiatric conditions.

Overview and management of post-intensive care syndrome

Any patient suffering from critical life-threatening illnesses in most cases require hospitalization, in the care unit (ICU) where they can receive essential life-sustaining treatments. This has created an impact including more than 50 million individuals world-wide. Although advancements, in technology and healthcare have increased survival rates many individuals who survive these illnesses experience long-term impairments known as post-intensive care syndrome (PICS). PICS encompasses cognitive and emotional challenges that significantly affect patients' quality of life and ability to return to their normal routines. Caregivers may also face similar emotional hurdles, a condition referred to as PICS-family (PICS-F). The prevalence of PICS varies but can affect up to 50% of ICU survivors. Cognitive difficulties can be noticed in, around 70% of instances impacting abilities like memory, focus, and decision-making. These difficulties can lead to emotions such, as sadness worry, and a condition known as traumatic stress disorder (PTSD). Multiple factors, such as delirium, sedation, and pre-existing health conditions play a role, in the emergence and severity of PICS. Diagnosing PICS involves comprehensive assessments covering physical, cognitive, and emotional dimensions. Screening should ideally commence during the ICU stay and continue post-discharge. Assessment tools such as the Montreal cognitive assessment (MoCA) and emotional functioning screenings aid in identifying PICS. This manifests physically through muscle weakness and fatigue, impacting mobility and daily activities. Effectively managing ICUs requires the implementation of models and strategies that optimize resource utilization. However, these strategies may entail challenges such as data integration and stakeholder involvement. Preventing PICS involves proactive measures like reducing sedation, promoting early mobility, and offering rehabilitation services. Addressing PICS necessitates a proactive approach, comprehensive patient care, and collaboration among multidisciplinary teams. The successful implementation of these strategies depends on thorough evaluation and active engagement with all stakeholders involved in ICU management.

Clasificación de gravedad y variables de influencia del síndrome poscuidado intensivo

ObjectiveThe study aims to characterize postintensive care syndrome by classifying the severity of the disease and identifying the variables of influence in 2 highly complex intensive care units for adults in Colombia. MethodA descriptive, cross-sectional, prospective study was carried out to characterize survivors of critical illness using the Healthy Aging Brain Care–Monitor in a sample of 135 patients. Postintensive care syndrome severity was classified using Gaussian mixture models for clustering, and the most influencing variables were identified through ordinal logistic regression. ResultsClustering based on Gaussian mixture models allowed the classification of postintensive care syndrome severity into mild, moderate, and severe classes, with an Akaike information criterion of 308 and an area under the curve of 0.80, which indicates a good fit; thus, the mild class was characterized by a score on the HABC-M Total scale≤9; the moderate class for a HABC-M Total score≥10 and≤42 and the severe class for a HABC-M Total score≥43. Regarding the most influencing variables, the probability of belonging to the moderate or severe classes was related to male sex (91%), APACHE II score (22.5%), age (13%), intensive care units days of stay (10.6%), the use of sedation, analgesia and neuromuscular blockers. ConclusionIntensive care units survivors were characterized using the HABC-M scale, which made it possible to classify postintensive care syndrome through Gaussian mixture models clustering into mild, moderate, and severe, and to identify variables that had the major influence on the presentation of postintensive care syndrome.

Incidence of Post Intensive Care Syndrome (PICS) in Cardiac Surgery

Incidence of Post Intensive Care Syndrome (PICS) in Cardiac Surgery

Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with post-intensive care unit syndrome.

Post-intensive care syndrome (PICS) is a term used to describe a constellation of new or worsened dysfunctions in the physical, cognitive, or mental health status of critically ill patients after their discharge from the intensive care unit (ICU). These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family. Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication advocates that patients should be respected and accepted when receiving medical services. Clinicians should attach importance to the communication mode of feelings, including connection, introduction, communication, ask, response, and exit 6 steps. To assess the impact of CICARE communication on the reduction of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms in patients transitioning from the ICU to other care settings. This prospective, randomized, controlled study was performed between October 2021 and March 2023. Intensive Care Unit Memory Tool was used to evaluate patients' ICU memory. The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms. Impact of Event Scale-Revised was utilized to assess the presence of PTSD. All data were processed and analyzed using R language software version 4.1.0. The measurement data were expressed as mean ± SD, and the t test was used. The count data were analyzed by the χ2 test and expressed as [n (%)]. In total, 248 subjects were included in this study. Among them, 206 were successfully followed up for three months after transfer from the ICU, and 42 cases were lost to follow-up. There was no significant difference in the composition of ICU memory between the two groups. The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model, as well as the adoption of only the motivational psychological intervention nursing model, demonstrated favorable effects on PICS. Both groups of patients showed a reduction in anxiety scores, depression scores, and PTSD scores following the implementation of these two nursing models. However, it is noteworthy that the experimental group exhibited greater improvements compared to the control group. Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.

The Impact of an Intensive Care Diary on the Psychological Well-Being of Patients and Their Family Members: Longitudinal Study Protocol.

Thanks to medical and technological advancements, an increasing number of individuals survive admission to intensive care units. However, survivors often experience negative outcomes, including physical impairments and alterations in mental health. Anxiety, depression, cognitive impairments, post-traumatic stress disorders, and functional disorders are known collectively as post-intensive care syndrome (PICS). Among the key triggering factors of this syndrome, memory impairment appears to play a significant role. This study aims to evaluate the impact of an intensive care diary on the psychological well-being of patients and their relatives after discharge from the ICU. Prospective observational study. The results of this study evaluate the impact of an ICU diary on the quality of life of ICU survivors and their family members.

Construction of a risk prediction model for detecting postintensive care syndrome-mental disorders.

Postintensive care syndrome (PICS) has adverse multidimensional effects on nearly half of the patients discharged from ICU. Mental disorders such as anxiety, depression and post-traumatic stress disorder (PTSD) are the most common psychological problems for patients with PICS with harmful complications. However, developing prediction models for mental disorders in post-ICU patients is an understudied problem. To explore the risk factors of PICS mental disorders, establish the prediction model and verify its prediction efficiency. In this cohort study, data were collected from 393 patients hospitalized in the ICU of a tertiary hospital from April to September 2022. Participants were randomly assigned to modelling and validation groups using a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was performed to select the predictors, multiple logistic regression analysis was used to establish the risk prediction model, and a dynamic nomogram was developed. The Hosmer-Lemeshow (HL) test was performed to determine the model's goodness of fit. The area under the receiver operating characteristic (ROC) curve was used to evaluate the model's prediction efficiency. The risk factors of mental disorders were Sepsis-related organ failure assessment (SOFA) score, Charlson comorbidity index (CCI), delirium duration, ICU depression score and ICU sleep score. The HL test revealed that p = .249, the area under the ROC curve = 0.860, and the corresponding sensitivity and specificity were 84.8% and 71.0%, respectively. The area under the ROC curve of the verification group was 0.848. A mental disorders dynamic nomogram for post-ICU patients was developed based on the regression model. The prediction model provides a reference for clinically screening patients at high risk of developing post-ICU mental disorders, to enable the implementation of timely preventive management measures. The dynamic nomogram can be used to systematically monitor various factors associated with mental disorders. Furthermore, nurses need to develop and apply accurate nursing interventions that consider all relevant variables.

Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], -0.04-0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, -0.13-1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.

Recent discoveries in preventing mental impairments and ICU staff interventions in post-intensive care syndrome

Introduction&#x0D; Mental impairments such as post-traumatic stress disorder, depression, and anxiety are alarming problems in the ICU-survivors population because of the higher survival rate due to medical, scientific and technological progress. There are more and more patients facing long-term emotional consequences of critical illness. The main purpose of this review is to describe recent research about possible interventions and methods of prevention of mental impairments after an ICU stay made since 2015.&#x0D; Review methods&#x0D; The review was made using online databases such as PubMed and Google Scholar.&#x0D; Brief description of the state of knowledge&#x0D; Recent trials included in our review suggest that the sedation strategy has no significant impact on mental impairments in ICU survivors. ICU diaries seem to be a well-accepted and cheap method of prevention of mental disorders after critical illness but their universal usefulness is difficult to determine because variable factors like hospital and country levels influence the trials on patients. Nurse-led intervention programs, virtual reality and antioxidants described in recent studies also show no significant decrease in PTS symptoms in ICU survivors. Initial effects of mobile apps-based psychoeducational programs are comparable to therapist-led programs.&#x0D; Summary&#x0D; We did not find any evidence-based revolutionary method of prevention or intervention to help improve the mental health of ICU survivors. We think that the growing seriousness of this problem will lead to further research to cope with this phenomenon.

Post-intensive Care Syndrome.

Post-intensive Care Syndrome.