What Is Post-intensive Care Syndrome?
As intensive care unit (ICU) mortality rates have declined in recent decades, it is becoming increasingly clear that those who survive intensive care units frequently experience significant physical, cognitive, and emotional health deficits that last for months to years after critical illness recovery. This syndrome, known as post-intensive care syndrome (PICS), can be minimized by implementing particular clinical procedures during hospitalization, although treatment frequently necessitates continuous outpatient supervision.
Who Is Affected by Post-intensive Care Syndrome?
Anyone who survives a critical illness requiring hospitalization in an intensive care unit (ICU) is at risk of acquiring post-intensive care syndrome (PICS). Along with the seriously ill intensive care unit survivor, the family and loved ones who offer the necessary care and support may experience some of the identical psychological and emotional symptoms as PICS. This is known as PICS-family (PICS-F). PICS impacts the patient's and family's quality of life.
What Rehabilitation Techniques Are Available for Post-intensive Care Syndrome?
1. Physical Rehabilitation:
Early Mobilization: Mobilization is an energy-intensive activity that aims to maintain and promote a person's mobility. Early mobilization begins within 72 hours of admission and continues throughout the ICU. Different approaches can be used to perform various methods of early mobilization, such as passive mobilization (bed mobility, neuromuscular electrical stimulation (NMES)), supported exercises (bed cycling, robotics, functional physical activity, and resistance workouts, transfers), active exercises (tasks associated with daily living, walking), or other exercises, such as cognitive exercises. Early mobilization is often suggested during an ICU stay since it can improve the period of ventilation and the duration of stay, delirium incidence, and strength of muscles upon discharge.
Although early ICU mobilization does not significantly affect long-term physical, functional, intellectual, or psychosocial results compared to usual care, short-term effects such as reduced mechanical ventilation, length of stay, or delirium frequency in the ICU can be demonstrated.
These are critical considerations for patients and their families. As a result, researchers advocate for the systematic, multidisciplinary execution of early mobilization of critically ill patients based on specified inclusion and exclusion criteria, with the optimum feasible dosage and frequency.
Physical Therapy: Patients with PICS frequently have ICU-AW (intensive care unit-acquired weakness), which causes limits in body functions and activities and a lower quality of life. Motor rehabilitation therapy is critical in treating these patients and preventing additional problems. Motor rehabilitation begins with diagnosing a motor impairment and continues after the patient is discharged.
Device-assisted therapy can help improve sensorimotor function (arm, hand, position, and walking function) and cardiopulmonary exercise capacity in critically ill patients by facilitating early mobilization and physical rehabilitation. Experts can only recommend device-assisted therapy for PICS patients with scientific evidence. Robot-assisted tilt tables with and without electrical stimulation, robot-assisted mobility training (bed cycling), robot-assisted-standing, and training for walking are all becoming more common in clinical practice.
2. Cognitive Rehabilitation: Intervention to treat cognitive impairment is an important and expanding field of study. Focusing on characteristics associated with cognitive deficits is one method to enhance cognitive outcomes. A meta-analysis of 28 studies examining possibly alterable risk factors for cognitive impairments following critical illness discovered that delirium, glucose dysregulation (low or high glucose), and hypoxia were possibly adjustable risk variables for cognitive deficits.
Cognitive rehabilitation, which comprises interventions to correct cognitive impairments that emerge after a severe illness due to brain damage, is one technique to improve cognitive function. Several approaches to cognitive rehabilitation include techniques or compensatory mechanisms that reduce weaknesses or improve strengths and automated mental rehabilitation using brain-training programs on computers (similar to traditional video games) to enhance or reclaim cognitive abilities. A research of 34 ICU survivors who received six weeks of mental rehabilitation along with integrated strengthening exercises and walking discovered a substantial increase in cognitive abilities compared to controls.
Delirium Prevention and Therapy: Preventing delirium in critically ill patients necessitates particularly skilled teams and multidisciplinary therapies. There is evidence that stressors (such as discomfort, starvation, dehydration, catheters, infusion systems, separation, disorientation, worry, and a lack of sleep) contribute to the development of delirium. In addition to cognitive and physical limitations, critically ill patients experience ICU-specific issues (monitor noise, chaos, separation) and simultaneous signs, including thirst, hunger, discomfort, and nervousness, which influence and exacerbate PICS symptoms. Communication devices help avoid delirium. Early movement (ranging from seated on the edges of the bed to walking alongside the clinician) and interaction with family members lower the probability of delirium significantly. Delirium raises the chances of getting PICS. Once delirium has developed, treatments are limited. Thus, delirium prevention may help to prevent or alleviate PICS symptoms.
3. Psychological Rehabilitation: Patients in critical condition are susceptible to mental and psychological illnesses. Months following discharge, depression, and nervousness are frequent. A multidisciplinary approach is advised in the ICU, including training in adaptability, mobilization, communication assistance, and information. Following discharge, patients should be directed to specific services and offered psychotherapy treatments. Only a PTSD (post-traumatic stress disorder) reducing effect was found in the systematic reviews. In the intervention group, resilience training decreased depression and anxiety, with the impact remaining stable over 12 weeks. Peris et al. discovered a significant improvement in psychological symptoms, a substantial decrease in PTSD symptoms, and an improvement in mental health.
ICU Diaries: Nurses, therapists, or family members keep an ICU diary to document incidents that typically cannot be remembered by critically ill patients. It might include images, psychoeducational data, and handwritten comments about occasions, visits, or patient development. Using ICU diaries generally lowers the risks of PTSD, depressive symptoms, and anxiety. Editing ICU diaries with a patient-centered focus by those with the appropriate training can be crucial. Critically ill patients and their families appear to have a generally good response, expressing results like a greater comprehension of what they have been through, successful management, an ongoing relationship development process, importance, and other advantages.
Conclusion:
The complex disease known as post-intensive care syndrome (PICS) has long-lasting repercussions. Patients' physical, mental, and cognitive needs must be addressed for prevention and management to be effective. Patients with PICS can recover remarkably and experience improved quality of life with the proper treatment and support from caregivers and family.
