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Post–Intensive Care Syndrome (PICS) and Strategies to Mitigate PICS

Mark E. Mikkelsen, MD, MSCE, Ramona O. Hopkins, PhD, and Carla M. Sevin, MD

The Society of Critical Care Medicine’s (SCCM)

Medical Journal

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Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals

No

Advances in critical care medicine have led to improved outcomes; as a result, most patients will survive their critical illness episode. However, many survivors do not return to their pre critical illness functional levels. Rather, survivors of critical illness often experience impairments in cognition, mental health, and physical health that endure. Research over the past 2 decades has increased our knowledge and awareness of these morbidities after critical illness. Post–intensive care syndrome (PICS), a term coined in 2012 to raise awareness of these impairments, is common after critical illness. Specifically, 34% of patients who experience shock and/or require invasive mechanical ventilation experience cognitive impairment at 12 months at a level consistent with moderate traumatic brain injury.
Symptoms of anxiety, depression, and/or posttraumatic stress disorder (PTSD) afflict approximately 25% of survivors of critical illness, and 27% of survivors are physically impaired at 1 year after critical illness. Together, 56% of survivors experience a new, enduring impairment in 1 or more of these domains, and 21% experience 2 or more impairments at 1 year.
Similarly, findings from a small telephone-based study that used patient report of problems found that 54% of patients developed impairments and 56% of patients had 2 or more impairments after critical illness. Related to the 3 domains that define PICS—impairments in cognition, mental health, and physical health survivors experience a myriad of challenges and functional impairments, including pulmonary dysfunction, particularly among survivors of acute respiratory distress syndrome (ARDS); chronic pain; sexual dysfunction; and functional disability related to contractures.These impairments contribute to the reduced health-related quality of life that has been observed among survivors of critical illness as well as the inability to return to full-time employment.

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