Early this year, when the world was first coming to grips with the spread of COVID-19 and the challenges it would present, Dr. Brad Butcher, a critical care medicine specialist at UPMC Mercy, was focused on what was coming next. “We heard that patients who required time in the intensive care unit, and particularly time on a mechanical ventilator, were staying on the ventilator for a very long time,” he said. “This is concerning because the longer people stay in bed, the more physical weakness can develop, and the longer they’re on ventilation, the more drugs they need to sedate them.” Additional medication increases the risk of patients developing delirium, which raises the likelihood of long-term cognitive complications from the critical illness. These conditions would only be intensified by the limited interactions with care providers and loved ones permitted by COVID-19 safety protocols. “We were very concerned that these patients would be at increased risk for anxiety, depression and post-traumatic stress disorder,” Butcher said. In other words, COVID-19 had the potential to create a perfect storm in the realm where Butcher and his colleague Tammy Eaton, C.R.N.P., specialize: Post-Intensive Care Syndrome (PICS). PICS is a set of conditions that have been around as long as critical care medicine, but it received a name only a decade ago. Addressing PICS is the mission of the UPMC Critical Illness Recovery Center (CIRC), which Butcher and Eaton founded at UPMC Mercy.

The Post-Intensive Care Syndrome and COVID-19: Crisis after a Crisis? study says, “At least 20% of the COVID-19 patients are reported to require supportive care in the critical care units. Patients infected with COVID-19 who are admitted to critical care often need 10 days of supportive care utilizing mechanical ventilation.” Since workers’ compensation represents only between one and two percent of the overall medical spend, insurers, employers and third-party administrators will not see a huge number of COVID-19 claims with ICU treatment. However, the seriously ill workers they do see may suffer from post-intensive care syndrome or PICS.

Patients with COVID-19 are staying longer than the average three to four days in the intensive care unit (ICU), says Megan Hosey, a rehabilitation psychologist at The Johns Hopkins Hospital’s medical ICU. This puts them at greater risk for developing post-intensive care syndrome (PICS). While more patients than ever are surviving after treatment in the ICU, research over the last two decades shows that survival can come with the cluster of physical, psychological and cognitive symptoms associated with PICS — hindering patients’ quality of life for weeks or years to come. Although the exact prevalence of PICS is unknown, “it happens in more patients than we probably realize,” says Hosey, and it is occurring in some patients with COVID-19.

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during theCOVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months.Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have beenpublished for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.