Introduction Post-Intensive Care Syndrome (PICS) is a multifaceted condition that affects many individuals who have survived critical illness and require intensive care unit (ICU) treatment. It encompasses a range of physical, cognitive, and psychological challenges that can persist long after discharge from the ICU. Understanding PICS is essential for patients, families, and healthcare providers, as it plays a crucial role in recovery and rehabilitation. This article will delve into the causes, symptoms, impact, and strategies for managing PICS, providing a comprehensive overview for those affected. Understanding Post-Intensest Care Syndrome PICS is characterized by a constellation of symptoms that arise following an extended stay in the ICU. While the immediate goal of intensive care is to stabilize and treat life-threatening conditions, the experience can lead to long-term effects that disrupt patients' quality of life. The syndrome typically manifests in three primary areas: Physical Impairments : Muscle weakness, fatigue, and mobility issues are common after critical illness. Prolonged bed rest, sedative medications, and mechanical ventilation can contribute to significant physical decline. Cognitive Impairments : Many survivors report memory, attention, and problem-solving difficulties. These cognitive challenges can be exacerbated by delirium experienced during ICU stay, which can lead to long-term cognitive dysfunction. Psychological Impairments : Mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD) are prevalent among ICU survivors. The traumatic nature of critical illness, along with the emotional toll of hospitalization, can lead to lasting psychological effects. The Causes of Post-Intensive Care Syndrome Several factors contribute to the development of PICS. Understanding these factors can help in identifying those at risk and facilitating early interventions: Severity of Illness : The more severe the illness, the greater the likelihood of developing PICS. Conditions that require prolonged ICU stays, such as sepsis, respiratory failure, or traumatic injury, increase the risk. Delirium : Many ICU patients experience delirium, a severe confessional state. Research indicates that delirium can lead to long-term cognitive impairments and increase the risk of psychological symptoms. Sedation and Immobility : The use of sedatives and the necessity of immobilization can contribute to muscle atrophy and cognitive decline. Extended use of ventilators can also lead to physical deconditioning. Psychological Factors : Pre-existing mental health conditions can exacerbate the risk of developing PICS. Patients with a history of anxiety or depression may be more vulnerable to the psychological impacts of their ICU experience. Support Systems : The availability and quality of social support during and after the ICU stay can influence recovery. Strong family and community support can mitigate some of the adverse effects of PICS. Symptoms of PICS The symptoms of PICS can vary significantly among individuals, but some common manifestations include: Physical Symptoms : Muscle weakness, joint pain, fatigue, and difficulties with coordination or balance are frequently reported. Many survivors also experience chronic pain or other physical ailments. Cognitive Symptoms : Patients may struggle with memory loss, trouble concentrating, confusion, or difficulty in performing daily tasks. Some report feeling "foggy" or mentally drained. Psychological Symptoms : Anxiety, depression, and PTSD can manifest as irritability, nightmares, flashbacks, or feelings of hopelessness. Survivors may also experience mood swings or emotional detachment. The Impact of PICS on Daily Life The repercussions of PICS extend beyond the individual, affecting families, caregivers, and communities. The impact on daily life can include: Challenges in Returning to Work : Cognitive impairments and physical limitations can make it difficult for survivors to return to their previous employment or perform everyday tasks, leading to financial strain. Family Dynamics : Families may struggle to adjust to the changes in their loved one, experiencing stress, frustration, and emotional fatigue. Caregivers often need support themselves, as they may be dealing with their own feelings of helplessness or anxiety. Social Isolation : Survivors of PICS may withdraw from social activities due to fatigue, cognitive challenges, or psychological distress. This isolation can further exacerbate feelings of loneliness and depression. Quality of Life : Overall quality of life can be significantly diminished due to the physical, cognitive, and psychological effects of PICS. Survivors may find it difficult to engage in hobbies, exercise, or maintain relationships. Strategies for Managing PICS Managing PICS involves a multi-faceted approach , including medical treatment, rehabilitation, psychological support, and lifestyle changes. Here are some strategies that can aid recovery: Early Intervention : Recognizing the signs of PICS early can help initiate appropriate interventions. Healthcare providers should monitor patients during their ICU stay and provide follow-up care post-discharge. Rehabilitation Programs : Physical, occupational, and speech therapy can aid in regaining physical strength and cognitive function. Customized rehabilitation programs can address specific needs, helping survivors regain independence. Cognitive Training : Engaging in cognitive exercises can improve memory, attention, and problem-solving skills. Various programs and apps are designed to stimulate cognitive function and aid in recovery. Psychological Support : Accessing mental health resources, such as counseling or support groups, can help individuals process their experiences and cope with anxiety or depression. Cognitive-behavioral therapy (CBT) is often effective in treating PTSD and other psychological symptoms. Family Involvement : Involving family members in the recovery process can provide emotional support and improve communication. Family education programs can help families understand PICS and learn how to provide effective support. Lifestyle Modifications : Encouraging healthy habits, such as regular exercise, a balanced diet, and good sleep hygiene, can support overall recovery. Mindfulness practices, like meditation or yoga, may also help reduce anxiety and improve emotional well-being. Peer Support : Connecting with other ICU survivors can foster a sense of community and understanding. Peer support groups provide a platform for sharing experiences, coping strategies, and encouragement. Patient Advocacy : Survivors and their families should be encouraged to advocate for themselves within the healthcare system. This includes discussing concerns, seeking second opinions, and actively participating in care decisions. Conclusion Post-Intensive Care Syndrome is a significant yet often overlooked consequence of critical illness. By understanding the complexities of PICS, its symptoms, and its impact on recovery, patients, families, and healthcare providers can work together to develop effective strategies for rehabilitation and support. Recovery is a journey that requires patience, understanding, and a commitment to holistic care. With the right resources and support, survivors of PICS can regain their quality of life and move forward into a healthier future. In navigating the challenges of post-intensive care syndrome, it is crucial to foster awareness, advocate for appropriate resources, and promote a compassionate approach to recovery. Ultimately, every survivor's journey is unique, but with the right tools and support, a fulfilling life beyond the ICU is possible.

Post-Intensive Care Syndrome (PICS) is a term used to describe the collection of physical, cognitive, and psychological symptoms that can persist after a patient leaves the intensive care unit (ICU). These effects can significantly impact the quality of life and may continue long after the immediate medical crisis has passed. Understanding PICS is crucial for effective recovery and long-term well-being, not only for patients but also for their families and caregivers. What is Post-Intensive Care Syndrome? PICS encompasses a range of symptoms that affect different aspects of a person's health following a stay in the ICU. These symptoms can be broadly categorized into three main groups: Physical Symptoms : These may include muscle weakness, fatigue, and reduced physical functioning. Prolonged bed rest and intensive medical treatments can lead to significant deconditioning and muscle atrophy. Cognitive Symptoms : Cognitive impairments can manifest as memory problems, difficulty concentrating, and decreased problem-solving abilities. These symptoms may result from prolonged sedation, delirium, or the underlying illness that necessitated ICU care. Psychological Symptoms : Emotional and mental health challenges are common and may include anxiety, depression, and post-traumatic stress disorder (PTSD). The trauma of a critical illness and the isolation often experienced in the ICU can contribute to these issues. Recent Advances in Understanding PICS Recent research has significantly advanced our understanding of PICS , shedding light on its prevalence, risk factors, and potential interventions. Key findings include: Prevalence and Risk Factors : Studies indicate that a substantial proportion of ICU survivors experience symptoms of PICS. Risk factors include the severity of the illness, the length of ICU stay, and the presence of pre-existing conditions. The use of certain medications and the occurrence of delirium during the ICU stay are also associated with a higher risk of PICS. Long-Term Effects : Research has shown that PICS can have lasting effects on individuals, impacting their ability to return to work and their overall quality of life. For many survivors, PICS symptoms persist for months or even years after leaving the ICU, highlighting the need for ongoing support and rehabilitation. Interventions and Management : Recent studies have explored various strategies for managing and mitigating PICS. These include: Early Rehabilitation : Initiating physical therapy and rehabilitation as soon as possible can help improve physical functioning and reduce muscle weakness. Early mobilization strategies have been shown to enhance recovery and reduce the long-term impact of ICU-related muscle atrophy. Cognitive Rehabilitation : Cognitive therapies and exercises can help address memory and concentration issues. Tailored cognitive rehabilitation programs are increasingly being integrated into post-ICU care to support cognitive recovery. Psychological Support : Addressing psychological symptoms through counseling, psychotherapy, and support groups is crucial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches have been shown to help manage anxiety, depression, and PTSD in ICU survivors. Family Involvement : Involving family members in the recovery process can provide emotional support and improve outcomes. Family education and support programs are beneficial in helping loved ones understand and manage the challenges associated with PICS. Strategies for Managing PICS Effective management of PICS requires a multi-faceted approach tailored to the individual needs of each patient. Here are some strategies that can support recovery and well-being: Comprehensive Assessment : A thorough assessment of physical, cognitive, and psychological health should be conducted upon discharge from the ICU. This helps in identifying specific needs and developing a personalized care plan. Integrated Care : Collaboration among healthcare providers, including physicians, nurses, physical therapists, occupational therapists, and mental health professionals, is essential for addressing the diverse aspects of PICS. Ongoing Monitoring : Regular follow-up appointments and assessments can help track progress and adjust the care plan as needed. Monitoring tools and assessments can also help in early detection of emerging issues. Patient Education : Educating patients and their families about PICS and its potential impact can empower them to participate actively in the recovery process. Providing information about available resources and support services is also important. Self-Care and Lifestyle Modifications : Encouraging patients to adopt healthy lifestyle habits, such as regular exercise, a balanced diet, and adequate sleep, can support physical and mental recovery. Stress management techniques, such as mindfulness and relaxation exercises, can also be beneficial. Support Networks : Connecting with support groups and community resources can provide additional emotional support and practical advice. Peer support from others who have experienced PICS can be particularly valuable. Conclusion Post-Intensive Care Syndrome represents a significant challenge for ICU survivors , but with a comprehensive and proactive approach to recovery, many individuals can achieve improved outcomes and enhanced quality of life. By understanding the symptoms, staying informed about recent research, and implementing effective management strategies, patients, families, and healthcare providers can work together to address the complexities of PICS and support a successful recovery journey.

As professionals in the healthcare industry, we understand the challenges individuals face post-intensive care unit (ICU) discharge. The journey from ICU to post-ICU life can be daunting, filled with various physical and emotional hurdles. In this blog post, we aim to provide valuable insights and strategies to help professionals and individuals navigate life after ICU, specifically focusing on Post-Intensive Care Syndrome (PICS). Understanding Post-Intensive Care Syndrome (PICS) PICS is a condition that affects patients who have been discharged from the ICU. It encompasses a range of physical, cognitive, and mental health issues that can persist long after the initial critical illness. Recent research about PICS highlights the importance of recognizing and addressing these ongoing challenges faced by ICU survivors. Strategies for Recovery Based on user insights and site activity data provided by PostICU, we have compiled effective strategies to aid in post-ICU recovery: Joining the "PICS Group Discussion" offered by PostICU provides a supportive environment for sharing experiences and seeking guidance from individuals who have gone through similar challenges. Engaging with peers can significantly impact one's recovery journey. The "PICS Expert Consultation" service enables individuals to ask questions, access resources, and receive expert advice on managing PICS. Consulting with non-medical professionals can offer valuable insights and support for a smoother recovery process. The availability of online booking for services on the PostICU platform ensures easy access to group discussions and expert consultations. This user-friendly feature enhances convenience and promotes better engagement with the supportive resources provided. Empowering Individuals to Thrive PostICU's commitment to creating a safe space for individuals affected by PICS is commendable. Through a combination of informative blog posts, interactive services, and a strong community network, PostICU empowers individuals to thrive beyond their ICU experiences. Conclusion In conclusion, the transition from ICU to post-ICU life is a critical phase that requires support, guidance, and understanding. PostICU's dedication to offering services that cater to the diverse needs of individuals recovering from critical illness is truly impactful. By leveraging the resources, support systems, and strategies discussed in this post, professionals and individuals can embark on a path towards holistic recovery and improved well-being. Let's continue to navigate life after ICU together, one step at a time. Harnessing personal insights and site activity data, this blog post is tailored to professionals seeking to enhance their understanding of PICS and support individuals in their post-ICU recovery journey.

There's a new group listed on LinkedIn titled Post Intensive Care Syndrome. Here is a link to view and join this group: https://www.linkedin.com/groups/12658739 Our group's first goal is to spread the news about our group, and to recruit as many members as possible. We're excited at the prospect of having a large community of post intensive care syndrome LinkedIn group members for a number of reasons: To provide educational resources to former ICU patients, their caregivers & families, the medical community, and the public. To share our belief that everyone in the medical community that provides direct care to people in the ICU, and that is involved in the aftercare of former ICU patients, plays an important role in the process of educating themselves, their peers and their patients about PICS symptoms. To provide education to everyone about the fact that PICS is a major health crisis. To recruit new group members to help educate group members. To encourage former ICU patients and their family members, with LinkedIn accounts, to join this group. ​ With the support of a growing group membership, we hope to position ourselves as a group with clout necessary to "get a seat at the table with decision-makers" at critical care organizations, hospitals, and health insurance companies. Should we be fortunate enough to get a "seat at the table," we hope to position ourselves to solicit advice from this group to share with decision makers about about commonsense solutions to help solved this complex but solvable medical, financial, sociological, problem. Our group also hopes to plans to enhance our existing library of articles, research, locations of PICS treatments centers, and other materials and information about the PICS. We'll ask group members to help us collect materials from PICS researchers, ICU physicians & nurses and others detailing the PICS symptoms to be aware of, availability of PICS clinical in your area and other treatment options. We'll also ask members to help us fashion surveys for our membership on a multitude of topics to find out what our majority finds to be the most important avenues for us to pursue together. If you'd like to participate in the leadership of this group or as an Admin, please drop us a message, at your convenience. Thank you!

Every year, more than 6 million patients are discharged from intensive care units (ICUs) in the United States (U.S.). At least one-third and as many as 80% experience a range of physical, cognitive and mental impairments associated with post-intensive care syndrome (PICS). Many of these patients still need care years after leaving the ICU. These numbers suggest that millions of people are currently afflicted with PICS, many with long term consequences. Moreover, thousands of survivors of the COVID-19 pandemic are facing symptoms similar to PICS long after their “recoveries” are thought to be complete. Given its pervasiveness and severity, what is the medical profession doing to identify, understand and treat PICS? PostICU.org has been tracking medical research journals to answer this question. For several years, we have been searching a number of on-line databases of peer-reviewed medical journals worldwide to find relevant articles. One of these, PubMed, has proven to be a particularly accessible database for the nonprofessional investigator. Founded in 1996, PubMed is a free resource supporting the search and retrieval of biomedical and life sciences literature. PubMed is maintained by the U.S. National Institutes of Health (NIH). Its database contains more than 30 million peer-reviewed journal citations. The full text of roughly one-quarter of these articles are open access publications available to the public at no charge. In 2012, less than two years after the seminal Society of Critical Care Medicine meeting that first defined PICS, the first four articles appeared in the PubMed database,. Since then, PICS has become a steady and now rapidly growing focus of medical research. This is shown in the following graph. A small handful of medical journal articles about PICS were published over the years from 2012 to 2015, after which the numbers began to shoot up dramatically. New PICS articles added to the PubMed database jumped from five in 2015 to 23 in 2016. In the last four years, the annual total has nearly quadrupled to an estimated 90 articles in 2020. In total, the PubMed database included 209 PICS articles as of November 1, 2020. Over 40% have been published in the last year. Most of the early articles tried to quantify the number of post-ICU patients afflicted with PICS and the distribution of various physical, mental and cognitive impairments among them. Many also focused on the expansion of protocols used by ICU nurses to include new and enhanced procedures to reduce delirium, enhance mobility and avoid other likely precursors of PICS. As the PICS knowledge base expanded, the medical community began to propose and test specific strategies to treat PICS patients in randomized controlled trials.These include establishment of post-ICU recovery centers specifically designed to help PICS patients.Other strategies include creating a network of peer support groups, including on-line groups, where PICS sufferers can talk freely among themselves.Another idea encourages ICU patients to maintain a diary of their experiences, worries and fears, with contributions by their families and ICU nurses, and continuing during post-discharge recovery.These topics will be examined more closely in future Jim’s Blogs.

The Society of Critical Care Medicine (SCCM) did a lot of the heavy lifting in designating post-intensive care syndrome (PICS) as a distinct medical condition. This makes sense. Every PICS sufferer was once critically ill and treated in a hospital intensive care unit (ICU). SCCM continued to lead after the 2010 inaugural PICS meeting, helping to build a place for PICS in the medical hierarchy. Early work was done by three task forces established during the initial meeting. They met periodically and presented reports at the Second PICS Stakeholders Meeting, also organized by SCCM, and held on September 24 and 25, 2012. After the presentations by the three task groups, attendees incorporated their respective recommendations into a single PICS Action Plan to guide future work. By then, the Awareness and Education Task Group had already published an information brochure and several videos on PICS. It had established an internet site about PICS called MyICUcare.com and it inserted a PICS definition into Wikipedia’s encyclopedia. With input from ICU survivors with PICS, an earlier SCCM brochure on leaving the ICU was modified to include a checklist of questions to identify when symptoms should be reported for follow-up medical care. Given that patients themselves may be unable to process complex information at their ICU discharge, the brochure was designed as much to help family members as the patients themselves. The Barriers Task Group recommended promoting the concept of “functional reconciliation,” making formal comparisons of a patient’s functional capabilities before hospitalization with their post-ICU status. This new concept included a checklist of physical, cognitive and mental health conditions and included case managers to ease transition of care and referral to appropriate care providers. Topics studied by the Research Task Group included partnering with other national organizations working on PICS, such as the Critical Care Societies Collaborative and the National Institutes of Health (NIH). The group also recommended seeking funding sources, including NIH institutes, the Agency for Healthcare Research and Quality, the Patient Centered Outcomes Research Institute, and various foundations. The Research Task Group also identified topics where further evidence was required to support a sound understanding of patient recovery from PICS. The group urged future research strategies to include a patient-centered focus, and include long-term outcome measures into studies. Development of datasets of patient-level data would benefit both research and practice evaluations, it concluded. At the second meeting in 2012, the number of stakeholder groups grew to 25, from 15 in 2010, and the total number of attendees expanded from 31 to 40. Like the early meeting, most attendees were medical professionals. Importantly, two ICU survivors with PICS were invited to attend the second meeting as patient advocates. This was one of the first and, unfortunately, still rare inclusions of PICS patients in medical decisionmaking. A fuller discussion of the SCCM Second Stakeholders Conference on PICS appears in an article published in Critical Care Medicine in December 2014 entitled “Exploring the Scope of Post-Intensive Care Syndrome Therapy and Care: Engagement of Non-Critical Care Providers and Survivors in a Second Stakeholders Meeting.”The article is included in the PostICU library on this website.

In late September 2010, a two-day meeting was held in Chicago, Illinois, to discuss the long-term consequences of extended intensive care unit (ICU) hospital stays after critical illnesses. The meeting was convened by the Society of Critical Care Medicine (SCCM), a leading international trade organization currently representing 16,000 physicians and nurses. In attendance were 31 medical specialists from 15 stakeholder groups invited by the SCCM. No post-ICU patients were included. During the meeting, the stakeholders approved a new medical term, post-intensive care syndrome (PICS), to describe “new or worsening problems in physical, cognitive or mental health status arising after a critical illness and persisting beyond acute care hospitalization.” This diagnostic term was created to help doctors determine what is “wrong” with patients who survive critical illness, but don’t recover as fully as expected. PICS itself was not invented at the Chicago meeting, of course. Patients who “didn’t make it all the way back” from severe medical crises were known for decades, but their symptoms were commonly ignored or even ridiculed. In the face of decades of stunning medical advances in saving lives, this collateral damage may have seemed a reasonable price to pay. No more. The SCCM 2010 meeting launched a feverous quest to learn more about the factors contributing to the emergence of PICS, to enhance knowledge of the full range of impairments affecting the quality of life of its sufferers, and to develop treatment protocols to promote recovery, if not a cure. PICS sufferers are now recognized by the medical community as needing and worthy of help with the health problems they endure, but did not create. This recognition may be just in time to help in the post-COVID era, where thousands of survivors of the virus are already experiencing persistent impairments. These unfortunates are termed “long haulers,” but their symptoms seem consistent with those of PICS. Hopefully, the decade of work so far to counter PICS, will help jump-start rapid development of treatments for COVID long haulers. The events in Chicago were reported in a March 2012 medical journal article, “Improving Long Term Outcomes after Discharge from Intensive Care: Report from a Stakeholders' Conference.” The article was co-authored by a long list of doctors led Dale M. Needham from Johns Hopkins University in Baltimore. It was published in Critical Care Medicine and is included in the PostICU library on this website.