The medical profession has long recognized that critical illness can have prolonged detrimental impacts on health and function. In 2010 a panel of experts convened by the Society of Critical Care Medicine agreed that the term “Post-Intensive Care Syndrome” (PICS) should be used to describe these long-term consequences. (Needham et al, 2012, Critical Care Medicine). Post-Intensive Care Syndrome encompasses “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalisation”.
Common physical impairments after critical illness include impaired pulmonary (lung) function, disuse atrophy (muscle wasting), and neuromuscular/Intensive Care Unit-acquired weakness. The latter includes critical illness polyneuropathy (impairment of multiple nerves) and critical illness myopathy (impairment of muscle) which can be diagnosed based on history, examination, and nerve conduction studies. These impairments may improve over time, but particularly in the case of severe critical illness polyneuropathy, some never fully recover.
Cognitive changes may include impairments in memory, attention, executive function, mental processing speed and visuospatial ability. The natural history with these cognitive changes is of significant improvement in the first year, but studies have shown that ongoing deficits may persist for years.
Psychiatric complications may include Depression, Anxiety and Post Traumatic Stress Disorder (PTSD). These conditions may persist for years after the critical illness, and also may occur in family members exposed to their loved one’s critical illness.
There remain gaps in our scientific understanding of the optimal approaches to prevent Post-Intensive Care Syndrome and how to promote optimal recovery if it has occurred. Expert opinion (such as that contained in the 2017 UK NICE guidelines: Critical Illness in Adults) advises that Rehabilitation is important in those at risk of morbidity after critical care, and for those disabled by PICS. Rehabilitation also has a role in educating patients regarding PICS, and identifying compensatory strategies for patients in the presence of long-lasting deficits. Rehabilitation should be individualised based on the patient’s needs. For example, it may encompass Physical Therapy, Occupational Therapy, Nutrition optimisation, Speech and Language therapy, Psychological Therapy and expert advice regarding return to work, and/or driving. A Physician in Rehabilitation Medicine is trained to assess a patient with PICS and oversee a patient’s rehabilitation, which may also require input from multiple other medical specialists.
This article was written by Dr Julia McLeod, Rehabilitation Physician