Post Intensive Care Syndrome

Post-ICU syndrome ( post-intensive care syndrome, PICS ), critical illness and defines a number of health problems in patients who have survived the intensive care unit. In general, PICS is distinguished from post-intensive care disorders due to traumatic brain injury and stroke. The problems seen in PICS are classified under three main headings: physical disorders, mental disorders and psychiatric disorders. A person may have symptoms involving only one of these areas, or two or three areas may be affected.

Critical illness refers to a situation where the person requires special follow-up, treatment and attention due to a life-threatening illness or after surgery. Improvements in survival rates after critically ill intensive care have allowed research to focus on the long-term health of these patients. It has been observed that many people experience significant functional impairment after intensive care. Our knowledge of PICS is more limited as much of the intensive care literature focuses on short-term outcomes such as survival. Sedation (sleeping) and long-term immobilization (immobility) stand out as common features seen in PICS patients.

The term post-intensive care syndrome was coined around 2010. Awareness increases in terms of long-term functional disorders after intensive care. Research has focused on identifying problems, preventing long-term complications, and more effective functional recovery.

Physical Disorders

The most well-known physical disorder associated with intensive care is intensive care unit-acquired weakness (ICU-related weakness). This is also called critical illness polyneuropathy. It was thought to be associated with prolonged immobility and deep sedation. In addition, severe infection and inflammation are also risk factors. Acquired weakness in IBU makes it difficult for the person to perform activities of daily living. For example, he cannot do things as he wants, such as dressing, moving around the room, using the bathroom. This negatively affects the psychology and independence of the person. The healing process is variable but can take up to a year.

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One of the physical problems caused by being inactive for a long time during hospitalization is joint contractures. Elbows and ankles are the most affected areas. Next come the hips and knees.

One of the causes of physical weakness may be malnutrition (not getting enough nutrients) during critical illness. These patients are fed intravenously (parenterally) or by tube (enteral or nasogastric). Nutrition may be interrupted for reasons such as digestive system disorders, surgical procedures that require the stomach to be empty. In people receiving mechanical respiratory support, lung functions may be affected for months or even years.

Mental Disorders

Mental functions such as memory, attention, problem solving and decision making may be affected. These effects are seen up to 80% after critical illness. Disorders in memory and executive functions are the problems that most affect daily living activities and complex mental tasks. Most of the patients recover within a year in terms of mental functions and show almost complete recovery. Risk factors for mental disorder after intensive care are delirium, previous cognitive damage, sepsis, and acute respiratory distress syndrome (ARDS). Factors such as impaired blood flow to the brain due to low blood pressure during sepsis, decreased oxygen supply to the brain due to respiratory failure, inflammation in the brain, and disruption of the blood-brain barrier may be the cause of mental disorders.

Psychiatric Disorders

The most common psychiatric disorders seen in PICS are depression and anxiety. Different conditions such as dementia, post-traumatic stress disorder (PTSD), persistent delusional behavior can also be seen. Anxiety and delusion may be associated with delusional memories formed during intensive care stay. Medically induced sedation can trigger the formation of such memories.

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Risk factors are similar to those for mental disorders. Severe sepsis, acute respiratory distress disorder, respiratory failure, trauma, hypoglycemia, hypoxemia increase the incidence of psychiatric disorders. Acquired weakness, long-term immobility and deep sedation also play an important role in IBU. Sleep disorders, which are common in ICU, may also be a factor. Being under the age of 50 increases the likelihood of developing female gender, previous alcohol abuse, anxiety, depression, PTSD, PICS-related psychiatric disorders.

PICS-related psychiatric disorders can be effectively treated with appropriate methods. But preventive strategies are more important. Keeping an intensive care diary can be helpful in this sense. Keeping a diary can prevent a person from forming delusional and false memories.

The intensive care process may also cause problems such as stress, anxiety and depression in family members.

Treatment

Preventive approaches are the main focus in the treatment of PICS. Limiting deep sedation and immobility has the greatest impact. Paying attention to sleep patterns, early recognition and intervention of delirium reduce the frequency of PICS. Early physical therapy and rehabilitation make a positive contribution. Ensuring adequate hygiene and nutrition are basic requirements. Discharged from intensive care but functional limitation for the issues identified for persons who continue physical therapy , occupational therapy , speech therapy, such as psychotherapy approach gives results

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