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With multiple advances in critical care, more patients are given the chance to survive life-threatening illnesses such as sepsis. This growing cohort of patients, however, grapples with a new challenge – post-intensive care syndrome (PICS). As the condition is increasingly recognized, the number of clinics devoted to helping patients with PICS recover is also on the rise.

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Post-intensive care syndrome (PICS) is a rapidly growing phenomenon in older adults. As survival rates from ICU hospitalizations have increased over the past few decades, the long-term cognitive, psychological, and physical sequelae of the illness have become a major challenge in critical care medicine. More than half of all ICU survivors suffer from at least one PICS-related impairment, and these effects can persist as long as 5 or more years.

PICS has become an increasingly important phenomenon in older adults for several reasons. First, the number of older adults with critical illness is rapidly increasing as the population ages and now accounts for about 50% of ICU admissions. Second, more than 70% of older adults hospitalized in the ICU develop delirium, which is a major risk factor for ICU-acquired cognitive impairments. Third, cognitive and functional impairment before an ICU hospitalization increases the likelihood of cognitive and functional decline afterward.

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Since critical care began over 50 years ago, there have been tremendous advances in the science and practice that allow more severely ill and injured patients to survive.Each year, millions of people are discharged back to the community. The recognition of long-term consequences for ICU survivors and their families is a growing concern. Critical care practitioners have always known that the patients have a long road to recovery after discharge from the ICU. In the 2 past decades, research has revealed how remarkably common and devastating long-term consequences of critical illness can be and how much some patients and their families suffer (1–9). These consequences in patients are referred to as postinten-
sive care syndrome (PICS) and in families as postintensive care syndrome-family (PICS-F).

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This powerpoint briefly introduced the website named criticalcarerecovery.com.

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Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes and assault. It's rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.

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People usually associate post-traumatic stress disorder with those who survive military combat, major catastrophes or assaults. But critically ill patients who survive an intensive care unit stay are at equally high risk for PTSD

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Millions of people worldwide have survived an admission to the intensive care unit (ICU), and the number of survivors is growing. While these patients have survived a life-threatening illness, most survivors suffer important long-term complications. Post-intensive care syndrome (PICS) is a term that describes the cognitive, psychological, physical and other consequences that plague ICU survivors. Our aim is to discuss the prevalence, risk factors, impact, prevention and management of PICS

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Rehabilitation has been identified by the World Health Organization (WHO) as an essential health strategy, alongside promotion, prevention, treatment, and palliative care. For the WHO, rehabilitation is a core component of universal health coverage and a central target of the United Nations Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. Rehabilitation focuses on the overall functioning of the whole person, including comorbidities. Consequently, rehabilitation of individuals who have experienced COVID-19 must consider not only the consequences of the disease but also the effects of treatments applied during the acute phase. For the WHO, functioning (the target of rehabilitation) is a key indicator of health, alongside mortality and morbidity, capturing the impact of diseases and injuries on body functions, human activities and participation. Rehabilitation inherently serves to reduce disability, with broad health, social, and economic impacts.

This Special Collection is the result of collaboration within Cochrane Rehabilitation, with rigorous involvement from stakeholders: the Steering Committee of the REH-COVER (Rehabilitation COVID-19 Evidence-based Response) action and the Cochrane Rehabilitation Advisory Board. The agreed list of relevant conditions is the product of a structured prioritization process for identifying the list of conditions, and subsequently review inclusion, except post-traumatic stress disorder (PTSD), for which Cochrane Mental Health and Neuroscience was consulted.

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The long-term effects of surviving COVID-19 have
become a new focus of attention for clinicians and
researchers. This focus has been driven partly by concerns
about late ill-effects of a previously unknown virus, but
recognised generic patterns of chronic disease after
critical illness also exist. These patterns are termed PICS,
an acronym both for post-intensive care syndrome and
for persistent inflammation, immunosuppression, and
catabolism syndrome. We recommend unifying post-
COVID-19 research aims with those of PICS research
and propose a novel approach to its management by
repurposing drugs that are approved, inexpensive, and
safe.

Brief description of media:

As a result of the current global health crisis, many more people than usual are having serious medical experiences. These include admissions to hospital with breathing difficulties, or transfers to critical care (intensive care) units. A significant proportion of these people will go on to develop symptoms of post-traumatic stress disorder (PTSD).

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Background

In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019.
Case presentation

Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial pressure to fraction of inspired oxygen, 180). On day 2 of her intensive care unit admission, reverse transcription–polymerase chain reaction confirmed coronavirus disease 2019. Her clinical status gradually improved, and she was extubated on intensive care unit day 5. She had a negative test result for coronavirus disease 2019 twice with repeated reverse transcription–polymerase chain reaction before being discharged to home after 10 days in the intensive care unit. Two weeks after intensive care unit discharge, the patient returned to our outpatient intensive care unit recovery clinic. At follow-up, the patient endorsed significant fatigue and exhaustion with difficulty walking, minor issues with sleep disruption, and periods of memory loss. She scored 10/12 on the short performance physical battery, indicating good physical function. She did not have signs of anxiety, depression, or post-traumatic stress disorder through self-report questionnaires. Clinically, she was considered at low risk of developing post–intensive care syndrome, but she required follow-up services to assist in navigating the healthcare system, addressing remaining symptoms, and promoting return to her pre–coronavirus disease 2019 societal role.
Conclusion

We present this case report to suggest that patients surviving coronavirus disease 2019 with subsequent development of acute respiratory distress syndrome will require more intense intensive care unit recovery follow-up. Patients with a higher degree of acute illness who also have pre-existing comorbidities and those of older age who survive mechanical ventilation for coronavirus disease 2019 will require substantial post–intensive care unit care to mitigate and treat post–intensive care syndrome, promote reintegration into the community, and improve quality of life.

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HEALTH systems must start ramping up services for helping people recover from intensive care treatment for coronavirus, doctors are warning. After spending several weeks on a ventilator, people will need extensive physical and mental rehabilitation for weeks or even months.