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Post-intensive care syndrome (PICS) may be the next public health crisis that we may face. The number of individuals who survive critical illness and intensive care hospitalization due to COVID-19 and develop PICS will continue to increase throughout this pandemic. 1

According to American Thoracic Society, many patients are unable to return to work and do not have the same energy level that they had before their illness. The long-term impacts of extended periods in ICU are not only highly disruptive to the health of individuals; but also to the society. Each additional day of bed-rest in the critical care is associated with an 11% decrease in muscle strength even at 24 months of follow up.

PICS was first described by the Society of Critical Care Medicine in 2012 as “new or worsening impairments in physical, cognitive or mental health status arising after critical illness or intensive care.”

Physical symptoms of PICS include muscle weakness, difficulty with walking and balance issues, problems with taking care of themselves (dressing, bathing), dyspnea, impaired pulmonary function which causes shortness of breath, decreased exercise tolerance, sexual dysfunction, joint immobility, voice changes, dysphagia and respiratory failure, and can persist for up to five years. It has been reported that 33% of the individuals after discharge from critical care even up to a year are unable to drive, limiting their mobility and social responsibilities.  2

Mental health symptoms range from mild anxiety or irritability to severe depression, sleep disturbances, and Post-traumatic Stress Disorder (PTSD) which is at an incidence ranging from 10% to 50%.

Cognitive decline is present in 30% to 80% of ICU survivors, varies in severity, and includes memory loss and dif­ficulty with concentration, comprehension and critical thinking. 3

People who develop PICS can experience any combination of these physical, emotional, and cognitive symptoms. They may be entirely new problems, or worsening of problems that were present before the critical illness. It can also persist for months or years.

Early rehabilitation combining mobilization with physiotherapy is emerging as an important strategy to treat critical illness polyneuropathy and myopathy, and to facilitate and improve long-term recovery and functional independence of patients, and shorten the duration of ventilation and hospitalization. Cadence Physical Therapy has a team of licensed Physical Therapists who are currently treating many Chronic Fatigue Syndrome patients that previously had COVID-19.

Managing PICS effectively requires a clearer understanding of the associated risk factors.  Prevention strategies such as: Early mobility programs, early psychological interventions bundled with cognitive rehabilitation are essential in order to limit the severity of ICU-acquired weakness and promote rapid functional recovery. 

References:

  1. DePierro J, Lowe S, Katz C. Lessons learned from 9/11: Mental health perspectives on the COVID-19 pandemic. Psychiatry Res. 2020;288:113024. doi:10.1016/j.psychres.2020.113024CrossRefGoogle Scholar
  2. Ohtake, Lee, Scott, Hinman, & Ali, 2018 Free PMC article
  3. Rothenhausler HB, Ehrentraut S, Stoll C, et al. Gen Hosp Psychiatry. 2001;23:90–96. [PubMed]