Post Intensive Care Syndrome (PICS) describes a set of disorders that are common in patients with severe illness and / or intensive care. Since the majority of the literature in intensive care medicine focuses on short-term outcomes (for example, survival), understanding of the patient's long-term development is relatively limited, since the latter is then considered to be healed.

Cognitive impairment includes deficits in memory, attention, speed of mental processing and problem solving. These impairments affect up to 80% of people who have experienced a serious illness. Most patients' symptoms improve or even disappear completely within the first year after treatment in the intensive care unit.

The underlying pathophysiology of cognitive impairment in critical care survivors is not well understood, but prolonged inflammation can play an important role

Introduction
Relatives of patients with severe sepsis have high risk of adverse psychological outcomes. Better knowledge about risk factors is needed.
Objectives
To predict psychological outcomes in relatives of patients at 90 days after death or discharge.
Methods
Prospective study on 4 ICUs in one German University hospital (04/2014 - 01/2015). The main relative of consecutive patients with severe sepsis were interviewed by phone at 90 days after patient discharge or death.Post traumatic stress symptoms (PTSS) were assessed by the Impact of Event Scale (IES), symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale(HADS). Predictors were chosen based on literature,including demographic data, satisfaction with ICU care and information and experience of end-of-life care in the ICU. All patients’ health status before severe sepsis and survivors’ health status at 90 days were assessed by the relative using the EQ-5D questionnaire. A new item was introduced: feeling over strained by the ICU experience with rating on a scale from 1 to 10. Linear regression analyses were used to identify predictors in the full sample and among relatives of deceased and surviving patients.
Results
143 relatives (64% response rate) participated. Fifty (35%)patients died in the ICU, 78 (55%) were alive at the time of the interview. Among relatives, median [IQR] age was54 [47,63], 73% were female, 43% were spouses and 39%were children of the patient, 78% were legal proxies. After90 days, 66 relatives (47%) experienced symptoms of PTSS; 55 (39%) and 41 (29%) suffered from symptoms of anxiety and depression, respectively. IES, HADS anxiety or depression scores did not differ between relatives of deceased and surviving patients. By multivariate analyses no item on satisfaction with the ICU experience or the experience of end-of-life care reached significance. Female gender and lower education of relatives were risk factors for some psychological symptoms in the full sample and among relatives of deceased patients. Tracheostomy was a predictor of IES in the full sample (p=.004), treatment on a surgical ICU was a predictor of IES among relatives of deceased patients (p=.004). The degree of feeling over-strained by the ICU experience was a predictor of IES, HADS anxiety and depression in the full sample as well as in the subsamples of relatives of deceased and surviving patients (p≤.021).ThedifferenceinEQ-5Dhealthstatuspredicted IES and HADS depression among surviving patients (p≤.049).
Conclusions
Feeling overs trained during the ICU stay might be the strongest predictor of relatives’ psychological symptoms after three months. Tracheostomy in the ICU might be a predictor for PTSS. Both should be investigated in prospective longitudinal or interventional studies to better assess and prevent relatives’ psychological burden after their ICU experience.

Objective

To evaluate patient post-intensive care syndrome (PICS-P) and caregiver burden 3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden.
Design

A prospective observational study was conducted over 26 months (January 2013–February 2015).
Setting

Medical-surgical ICU and follow-up consultation in Portugal.
Patients or participants

Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study.
Main variables of interest

In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder).
Results

A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden.

Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p=0.030 vs p=0.008).

When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden.
Conclusions

The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden.