Brief description of media:

Post-intensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment, compared to older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared to other geriatric populations.Second,as caregivers themselves age, caring for this unique burden can be more challenging compared to other geriatric populations. Third, evidence for models of care centered on patients with multi morbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multi morbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.

Brief description of media:

Research has shown an increased prevalence of psychological distress and acute cognitive impairment in patients who have experienced hospitalization within the intensive care setting (Myers, Smith, Allen, & Kaplan, 2016; Pandharipande et al., 2013). Periods of mechanical ventilation, sensory deprivation, presence of noxious stimuli, and using sedation medication increase a patient’s risk of developing delirium and may result in hallucinations, traumatic memories of medical events, or the absence or fragmentation of memories throughout their intensive care experience (Myers et al., 2016). In 2010, stakeholders from the Society of Critical Care Medicine identified this phenomenon as Post Intensive Care Syndrome (PICS) characterized by new or worsening physical, cognitive, or mental health problems after critical illness (Needham et al., 2012). PICS manifests in numerous ways, including anxiety, depression, and post-traumatic stress disorder (PTSD), as well as impaired global cognition and executive function (Myers et al., 2016). Current literature regarding intensive care survivors indicates that 30% of patients will experience depression and 70% will experience anxiety after discharge from the intensive care unit (ICU), with one third of patients developing PTSD symptoms in the first 2 years after critical illness (Bienvenu et al., 2013; Myers et al., 2016). Additionally, the duration of delirium can be an independent risk factor for below-baseline global cognition, as well as for impairment in executive functioning after discharge from the ICU (Pandharipande et al., 2013). In an effort to reduce the occurrence of PICS, health care professionals have used numerous non-pharmacological interventions, including early mobilization, environmental modifications, and the ICU diary (Álvarez et al., 2017; Garrouste-Orgeas et al., 2012; Schweickert et al., 2009).

Brief description of media:

The objective of this power point is to: Define Post-intensive care Syndrome (PICS), Associated risk factor, and long term consequences; recognize available resources to address PICS through education, therapy, and support groups; and integrate knowledge into practice to guide at risk patient/families toward available resources.

Brief description of media:

The power point main points:
PICS is a big deal for patients and families and it does not go away as soon as they leave the ICU
Awareness and advocacy are crucial
PICS is going to be an on-going research point in the next decade, with several large RCT’s and clinical practice guidelines in review process to be published
*Survival by itself is not a patient-centered endpoint*
From a hospital metrics and bench-marking standpoint, surviving an ICU admission is typically where the data collection ends

Brief description of media:

Due to the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments due to critical illness, known as post-intensive care syndrome (PICS). This paper focuses on PICS-related cognitive, psychological, and physical impairments, and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS, and what roles geriatric psychiatrists could play in the future of this rapidly growing population.

Brief description of media:

Survivors of critical illness and their caregivers frequently face long-term
impairments of cognition, mental health, mobility and beyond, which
demand for a patient-centred transition management and well-coordinated,
outpatient post-ICU care.

Brief description of media:

The terms intensive care unit(ICU) syndrome and ICU psychosis have been used interchangeably to describe a cluster of psychiatric symptoms that are unique to the ICU environment. It is often postulated that aspects of the ICU, such as sleep deprivation and sensory overload or monotony, are causes of the syndrome. This article reviews the empirical support for these propositions. We conclude that ICU syndrome does not differ from delirium and that ICU syndrome is caused exclusively by organic stressors on the central nervous system. We argue further that the term ICU syndrome is dangerous because it impedes standardized communication and research and may reduce the vigilance necessary to promptly investigate and reverse the medical cause of the delirium. Directions for future research are suggested.

Brief description of media:

Background: There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.
Methods: We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 1⁄4 5; n2 1⁄4 5; n3 1⁄4 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.
Results: We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and
(4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).
Conclusions: We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily
applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.

Brief description of media:

During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient’s recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staH to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient’s ICU admission and an ongoing narrative outlining day-to-day activities.

Brief description of media:

Survivors of intensive care are known to be at increased risk of developing longer-term psychopathology issues. We present a large UK multicentre study assessing the anxiety, depression and post-traumatic stress disorder (PTSD) caseness in the first year following discharge from an intensive care unit (ICU).

Brief description of media:

Anyone who survives a critical illness that warranted admission to an intensive care unit (ICU) is susceptible to developing post-intensive care syndrome (PICS).

Brief description of media:

The American Psychological Association (APA) developed this guideline to
provide recommendations on psychological and pharmacological treatments for post traumatic stress disorder (PTSD) in adults.