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Post Intensive Care Syndrome-What should you know and how can you manage it?

Introduction

People who survive life threatening illness often have a group of persisting problems. More than half the people admitted in the ICU have some lingering effects which are grouped together as Post-intensive care syndrome (PICS). These problems can greatly affect the quality of lives of survivors of critical illness in many ways including physical or mental effects and the ability to think or function in daily life. Many patients are unable to return to work or their pre-illness routine and do not have the same energy level that they had before their illness.

What kind of problems are seen with PICS?

Persons who develop PICS may have one or more of

  • Problems with physical functions
    • Pain
    • Weakness
    • Difficulty with breathing
    • Difficulty with movement
    • Difficulty with exercise
  • Problems with mental function
    • Anxiety
    • Depression
    • Irritability
    • Post-traumatic stress disorder
  • Problems with cognitive function
    • Difficulty in remembering.
    • Difficulty in memory
    • Difficulty in thinking or reasoning

These can be new problems that arise after the illness or worsening of an existing problem

Who can get PICS?

People with

  • Prolonged hospitalization
  • Severe infection
  • Low oxygen levels
  • Low blood pressure
  • Acute respiratory distress syndrome
  • Delirium
  • Had mechanical ventilation

How is PICS treated?

The treatment for PICS is based on the specific symptoms.

  • Weakness and deconditioning can be treated with physical therapy and exercise programs.
  • Mental health symptoms such as depression or anxiety can be treated with a combination of therapy and medications.
  • If cognitive impairment results in difficulty thinking, remembering or concentrating, a formal evaluation by a neurologist specialist may help.
  • Occupational therapy may help ICU survivors manage these new difficulties and improve symptoms.

Try to spend time together and offer a caring environment. This includes

  1. Build a daily routine
  2. Have a regular time for activities including bathing
  3. Doing some pleasant activities together
  4. Have your meals together
  5. Discuss past pleasant memories
  6. Play the music that the person used to enjoy and like
  7. Offer reassurance to the patient
  8. Do not pressurize the patient or force them into activities. This has to be a balance as we don’t want the patient not doing anything or overdoing something.
  9. Start with simple breathing exercises and movement exercises (https://ammaerf.in/getting-back-to-normal-information-for-persons-who-had-coronavirus-covid-19-infection/)
  10. Provide a balanced, soft, nutritious warm freshly prepared diet. (https://ammaerf.in/getting-back-to-normal-information-for-persons-who-had-coronavirus-covid-19-infection/)
  11. Spend time listening to the patient.
  12. Gentle touches, hugs, holding hands can help (if the person does not mind those).

Will PICS resolve?

The symptoms of PICS can last for many months or even years.

Take it as small, short steps. One day at a time and look for small improvements.

Do not insist on a recovery schedule or force a recovery schedule. Let it flow with small steps each day.

Show acceptance and caring and let them know they still matter even with reduced functionality.

DO NOT START OR STOP ANY TREATMENT WITHOUT THE ADVICE OF A QUALIFIED MEDICAL PROFESSIONAL.

It is very important that family members also take care of themselves. Seeing someone you love in such a state can lead to depression, anxiety and stress in caregivers. Adequate rest, simple exercises, breathing, yoga, meditation, a good diet and a healthy lifestyle and enough time to just watch the world flow by can help caregivers. A relaxed caregiver transfers those vibes to the patient as well.

Select References

  1. Am J Respir Crit Care Med Vol. 201, P15-P16, 2020
  2. Bangash MN, Owen A, Alderman JE, Chotalia M, Patel JM, Parekh D. COVID-19 recovery: potential treatments for post-intensive care syndrome. Lancet Respir Med. 2020 Nov;8(11):1071-1073. doi: 10.1016/S2213-2600(20)30457-4. Epub 2020 Oct 12. PMID: 33058770; PMCID: PMC7550044.
  3. Smith JM, Lee AC, Zeleznik H, Coffey Scott JP, Fatima A, Needham DM, Ohtake PJ. Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome. Phys Ther. 2020 Jul 19;100(7):1062-1073. doi: 10.1093/ptj/pzaa059. PMID: 32280993; PMCID: PMC7188154.
Dr Praveen Nirmalan

Written by Dr Praveen Nirmalan

Dr. Nirmalan did his basic medical education from Thrissur, Kerala and followed it with a PG Diploma in Ophthalmology from Aravind Eye Care System, Madurai and a Vitreo-retinal Fellowship from Mumbai. Subsequently, he completed his MPH and a Public Health Ophthalmology Fellowship from the Johns Hopkins School of Public Health in the USA. He has led community-based and clinical research in some of the top eye care institutes of India and led a clinical research program at a top tier obstetric and neonate institute as well. He has experience chairing Ethics Committees and has helped with the setting up of Institutional Review Boards. Besides mentoring clinical faculty, he has mentored DNB and PhD students through their dissertation work and research methods.

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