Post Intensive Care Syndrome (PICS) and its clinical features
Post intensive care syndrome (PICS) is a constellation of new or
worsening impairments in physical, mental, or cognitive abilities in
critical illness survivors who have received intensive
care10,13. Clinical features of the elements of PICS
are cognitive, mental health and physical impairment. While PICS affects
mostly the survivor, it can also affect the family member of the
survivor, especially their mental
health13.
According to Harvey and Davidson 13, although not
among COVID-19 survivors, the symptoms of mental (e.g. anxiety) and
cognitive impairment occurred in 23-48% and 30-80% of critical illness
survivors with PICS in a developed country. Similarly, physical
consequences, including ICU-acquired weakness, occur in 25-80% of
individuals on mechanical ventilation for more than four
days13.
Cognitive impairment resulting from PICS affects the executive function,
memory, attention, visuo-spatial and processing speed, and this could
persist months to years after discharge from critical
care14. Cognitive impairment negatively impacts
independent functioning such as driving and managing complex medication
resulting in reduced quality of life14. Individuals
with delirium14 and pre-existing cognitive deficits
could be at a higher risk of PICS-related cognitive
impairments15.
Examples of mental health impairment include anxiety, acute stress
disorders, post-traumatic stress disorder, and depression. These
symptoms co-occur in critical illness survivors16.
Unfortunately, the nature of COVI-19 disease which entails that patients
are isolated limits the presence of family members and could further
worsen mental health outcomes. The impact of poor mental health and
persistent delusional memories could be functionally
debilitating8.
Physical impairment affects pulmonary, neuromuscular and physical
functioning. Ohtake et al9 in a systematic review of
15 studies, used the International Classification of Functioning,
Disability and Health (ICF) framework to identify the impairment of body
functions and structures, activity limitations, and participation
restrictions associated with PICS. See table 1